Provider Demographics
NPI:1578668802
Name:COLLINS, ANDY (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:HAROLD
Other - Middle Name:ANDERSON
Other - Last Name:COLLINS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1339 MORELAND DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-4325
Mailing Address - Country:US
Mailing Address - Phone:423-239-7450
Mailing Address - Fax:423-239-7451
Practice Address - Street 1:1339 MORELAND DR
Practice Address - Street 2:SUITE 1
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-4325
Practice Address - Country:US
Practice Address - Phone:423-239-7450
Practice Address - Fax:423-239-7451
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS33691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice