MEDICARE: YVETTE RENEE COLLINS D.D.S.

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	1223G0001X	General Practice Dentistry	20296	IL

General Provider Information

NPI Number	:	1063628030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE RENEE COLLINS D.D.S.

Provider Business Mailing Address
First Line	:	222 W HURON ST
Second Line	:	4005
City	:	CHICAGO
State	:	IL
Zip	:	60610-3627
Country	:	US
Telephone Number	:	312-335-1441
Fax Number	:	312-335-1477

Provider Business Practice Location Address
First Line	:	222 W HURON ST
Second Line	:	4005
City	:	CHICAGO
State	:	IL
Zip	:	60610-3627
Country	:	US
Telephone Number	:	312-335-1441
Fax Number	:	312-335-1477

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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