Provider Demographics
NPI:1538161641
Name:COLLINS, DAVID FOX (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FOX
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 N HIGH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SPEEDWAY
Mailing Address - State:IN
Mailing Address - Zip Code:46224-2001
Mailing Address - Country:US
Mailing Address - Phone:317-293-0471
Mailing Address - Fax:317-293-0472
Practice Address - Street 1:3049 N HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SPEEDWAY
Practice Address - State:IN
Practice Address - Zip Code:46224-2001
Practice Address - Country:US
Practice Address - Phone:317-293-0471
Practice Address - Fax:317-293-0472
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120064791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12006479Medicare UPIN