| Name: | Collins Family Dentistry, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 05 Jan 2009 (16 years ago) |
| Entity Number: | 000-428-719 |
| Register Number: | 000428719 |
| County: | Chambers |
| Place of Formation: | Chambers County |
| Principal Address: | VALLEY, AL |
| Registered Office Street Address: | 1902 48TH STVALLEY, AL 36854 |
| Registered Office Street Address ZIP Code: | 36854 |
Activities
DENTISTRY PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306868401 | 2006-07-25 | 2023-03-07 | 2105 BROAD AVE, STE E, LANETT, AL, 36863, US | 2105 BROAD AVE, STE E, LANETT, AL, 368633117, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-642-2200 |
Authorized person
| Name | DR. PAIGE J COLLINS |
| Role | DENTIST |
| Phone | 3346422200 |
Taxonomy
| Taxonomy Code | 122300000X - Dentist |
| License Number | 4359 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 4617 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 124Q00000X - Dental Hygienist |
| License Number | 5480 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 124Q00000X - Dental Hygienist |
| License Number | 5836 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS PROVIDER NUMBER |
| Number | 91622 |
| Issuer | UNITED CONCORDIA PROVIDER |
| Number | 860466 |
| Name | Role |
|---|---|
| COLLINS, PAIGE J | Agent |
| Name | Role |
|---|---|
| COLLINS, PAIGE J | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
