Active NPI
Raven Collins
- General Practice Dentistry
- Holly Ridge, NC
National Provider Identifier
1891255584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11426
- Practice address
- 200 Hwy 17 N
Holly Ridge, NC 28445 - Phone
- (910) 329-8191
- NPI assigned
- Mar 20, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11426 | NC | Primary |
Addresses
Primary practice location
200 Hwy 17 N
Holly Ridge, NC 28445
Mailing address
81 Habersham Ave
Rocky Point, NC 28457-3303
Phone (704) 640-2639
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11426 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663891200000",
"number": "1891255584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "81 HABERSHAM AVE",
"city": "ROCKY POINT",
"state": "NC",
"postal_code": "284573303",
"telephone_number": "704-640-2639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HWY 17 N",
"city": "HOLLY RIDGE",
"state": "NC",
"postal_code": "28445",
"telephone_number": "910-329-8191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLINS",
"first_name": "RAVEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-03-20",
"last_updated": "2022-09-23",
"certification_date": "2022-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "11426",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holly Ridge, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.