Chaz Taylor Collins, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

0401417480 Issued in VA

Practice address

10283 Bristow Center Dr
Bristow, VA 20136-2240

Phone

(703) 565-2920

NPI assigned

Jun 25, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bristow Fountain Dentistry, PC

  • Dentist
  • Bristow, VA
  • NPI 1447818919
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1801466602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2095 MOUNTAIN RD",
            "city": "HAYMARKET",
            "state": "VA",
            "postal_code": "201691552",
            "telephone_number": "703-554-2007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10283 BRISTOW CENTER DR",
            "city": "BRISTOW",
            "state": "VA",
            "postal_code": "201362240",
            "telephone_number": "703-565-2920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "CHAZ",
        "middle_name": "TAYLOR",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-25",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401417480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Cisnero, MS, LPC
• Katelyn E Clark, LPC
• Patricia Clubb, O.D.
• Paul T Colbourne, O.D.
• Kylie Rachelle Coley
• Carlos Joel Contreras, PT, DPT
• Core Transportation, LLC
• Corevita Medical Equipment LLC
• Corner Piece LLC
• Estefania Cruz de Pina, LPC

• All providers in Bristow, VA
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.