Jeffrey Alan Colligan, D.M.D., M.S.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Practice address

160 S Bellwood Dr Ste C
East Alton, IL 62024-2086

Phone

(618) 258-1244

NPI assigned

Aug 20, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 22, 2016 through Jan 22, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Metro East Periodontics, PLLC

  • Dental Clinic/Center
  • East Alton, IL
  • NPI 1801509666

  Periodontics

  NPD (past)

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

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187568000000",
    "number": "1831382233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 S BELLWOOD DR STE C",
            "city": "EAST ALTON",
            "state": "IL",
            "postal_code": "620242086",
            "telephone_number": "618-258-1244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 S BELLWOOD DR STE C",
            "city": "EAST ALTON",
            "state": "IL",
            "postal_code": "620242086",
            "telephone_number": "618-258-1244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLIGAN",
        "first_name": "JEFFREY",
        "middle_name": "ALAN",
        "credential": "D.M.D., M.S.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-20",
        "last_updated": "2007-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chen Wen Y
• Wen Y Chen, MD
• Anthony B Chin, D.M.D.
• Christian Social Services of Illinois
• Rebecca Lee Coalson, DMD
• Sarah Crockett, COTAL
• Sharon Diaz
• Keith W Dickey, D.D.S.
• Cynthia H Dormans, LCSW
• Kelly Dorris

• Periodontics in East Alton, IL
• Providers in East Alton, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.