MEDICARE: KIRK C COLLIER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	5530	KS
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	013093	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4803373206	OTHER	KS	FED TAX ID

General Provider Information

NPI Number	:	1306825401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK C COLLIER DDS

Provider Business Mailing Address
First Line	:	PO BOX 411863
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64141-1863
Country	:	US
Telephone Number	:	913-579-9025
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 W 83RD ST
Second Line	:	SUITE 203
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-5121
Country	:	US
Telephone Number	:	913-381-5194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	07/08/2007

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