Mark C Kilcollin, DDS
Individual provider Active NPI Dentist · Union, WV
NPI 1598844748 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1598844748
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2092 (WV)
- Practice address
- Health Center Drive
Health Center Building
Union, WV 24983 - Phone
- (304) 772-3333
- Fax
- (304) 772-3512
- NPI assigned
- Nov 6, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2092 | WV | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Katherine L Kilcollin, DDS PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2092 | WV | Yes |
Addresses
Primary practice location
Health Center Drive
Health Center Building
Union, WV 24983
Mailing address
PO Box 618
Health Center Drive
Union, WV 24983-0618
Phone (304) 772-3333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0135408000 | Medicaid | WV |
Other providers in Union, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.