Provider Demographics
NPI:1043601826
Name:JILL KOLLAR DMD PROFESSIONAL LLC
Entity Type:Organization
Organization Name:JILL KOLLAR DMD PROFESSIONAL LLC
Other - Org Name:PRECISION DENTAL OF WINDSOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:KOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-988-1817
Mailing Address - Street 1:1580 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-7918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1580 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-7918
Practice Address - Country:US
Practice Address - Phone:970-988-1817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-14
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN00201892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty