Kollin Stiner
Individual provider
Active NPI
Dentist · Travis Afb, CA
NPI 1366752255 · NPPES record last updated May 31, 2016
Key facts
- NPI
- 1366752255
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D12817 (MN)
- Practice address
- 101 Bodin Cir
Travis Afb, CA 94535-1809
- Phone
- (707) 423-7069
- NPI assigned
- Oct 14, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20170922002211 |
MN |
Order and Referring Only - Dentist
Practitioner - Dentist |
2062702020 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| D12817 | MN | MD | Dentist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Dentist |
122300000X |
D12817 |
MN |
Yes |
Addresses
Primary practice location
101 Bodin Cir
Travis Afb, CA 94535-1809
Mailing address
2020 1St Ave
Hibbing, MN 55746-1728
Phone (218) 263-8951
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| D12817 | Other | MN | DENTAL LICENCE NUMBER |
Other providers in Travis Afb, CA
- Corey Mark Stanley, D.D.S.
- Robert Michael Stanley, CRNA
- Joshua Jon Stefanik, PT
- Bill Steh, PHD
- Brian David Stephens, M.D., M.S.
- Justin Stinson
- Tara Aleyne Stogdill, PHARM.D.
- Benjamin E Stone, D.O.
- Sara Rebecca Storch, MD
- Rachel M Stout, DO
All providers in Travis Afb, CA
· Dentist in California