Christopher Kollath, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2021023768 Issued in MO

Practice address

3612 S Clark St
Mexico, MO 65265-4104

Phone

(573) 581-4352

NPI assigned

Jun 30, 2021

Last updated

Jun 30, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brick City Dental LLC

  • Dental Clinic/Center
  • Mexico, MO
  • NPI 1184389603
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1720658826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3612 S CLARK ST",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652654104",
            "telephone_number": "573-581-4352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3612 S CLARK ST",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652654104",
            "telephone_number": "573-581-4352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLATH",
        "first_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-30",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2021023768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MO DENTAL BOARD, DENTAL LICENSE",
            "identifier": "2021023768",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kelsey Kingsborough, APRN
• Kimberly Mae Kirklin, LCSW
• Ashley F Kreyling
• Kayla Marie Kueny, MS. CCC-SLP
• Lab One LLC
• Laura Lasher, OTD
• Sara Rose Lebel, LPC

• General Practice Dentistry in Mexico, MO
• Providers in Mexico, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.