Provider Demographics
NPI:1447321773
Name:COLLINS, DONALD RAY (DMD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RAY
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W WOODFORD ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1153
Mailing Address - Country:US
Mailing Address - Phone:502-839-3111
Mailing Address - Fax:502-839-4133
Practice Address - Street 1:107 W WOODFORD ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1153
Practice Address - Country:US
Practice Address - Phone:502-839-3111
Practice Address - Fax:502-839-4133
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist