Healthcare Provider Details

I. General information

NPI: 1194882605
Provider Name (Legal Business Name): WILLIAM EVERETT COLLINS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 ALBEN BARKLEY DR BLDG ROOM230
PADUCAH KY
42001-6788
US

IV. Provider business mailing address

501 S PRESTON ST
LOUISVILLE KY
40202-1701
US

V. Phone/Fax

Practice location:
  • Phone: 270-534-3437
  • Fax:
Mailing address:
  • Phone: 270-534-3437
  • Fax: 270-554-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6534
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6534
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: