Kevin E Collins, D.D.S.
Individual provider Active NPI Dentist · Lagrange, IL
NPI 1972884955 · NPPES record last updated Sep 2, 2011
Key facts
- NPI
- 1972884955
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 1914819 (IL)
- Practice address
- 475 W. 55TH St.
Suite 204
Lagrange, IL 60525-3566 - Phone
- (708) 354-5575
- Fax
- (708) 354-5504
- NPI assigned
- Sep 2, 2011
- 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 |
|---|---|---|---|
| 1914819 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kevin E Collins DDS PC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1914819 | IL | Yes |
Addresses
Primary practice location
475 W. 55TH St.
Suite 204
Lagrange, IL 60525-3566
Mailing address
475 W. 55TH St.
Suite 204
Lagrange, IL 60525-3566
Phone (708) 354-5575
Other providers in Lagrange, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2011. 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.