Healthcare Provider Details

I. General information

NPI: 1306825401
Provider Name (Legal Business Name): KIRK C COLLIER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W 83RD ST SUITE 203
PRAIRIE VILLAGE KS
66208-5121
US

IV. Provider business mailing address

PO BOX 411863
KANSAS CITY MO
64141-1863
US

V. Phone/Fax

Practice location:
  • Phone: 913-381-5194
  • Fax:
Mailing address:
  • Phone: 913-579-9025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5530
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number013093
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: