Kristin J Collard, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12011034A Issued in IN

Practice address

1 Professional Ctr Ste 206
2100 North Main Street
Crown Point, IN 46307-1882

Phone

(219) 663-9500

Fax

(219) 663-9595

NPI assigned

May 8, 2008

Last updated

Sep 6, 2011By the provider in NPPES

Sex

Female

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

Enrolled in IN

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1210204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315267200000",
    "number": "1861669905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PROFESSIONAL CTR STE 206",
            "address_2": "2100 NORTH MAIN STREET",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463071882",
            "telephone_number": "219-663-9500",
            "fax_number": "219-663-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PROFESSIONAL CTR STE 206",
            "address_2": "2100 NORTH MAIN STREET",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463071882",
            "telephone_number": "219-663-9500",
            "fax_number": "219-663-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLARD",
        "first_name": "KRISTIN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-08",
        "last_updated": "2011-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011034A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Crown Point, IN
• Providers in Crown Point, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.