Provider Demographics
NPI:1063628030
Name:COLLINS, YVETTE RENEE (DDS)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:RENEE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W HURON ST
Mailing Address - Street 2:4005
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3627
Mailing Address - Country:US
Mailing Address - Phone:312-335-1441
Mailing Address - Fax:312-335-1477
Practice Address - Street 1:222 W HURON ST
Practice Address - Street 2:4005
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3627
Practice Address - Country:US
Practice Address - Phone:312-335-1441
Practice Address - Fax:312-335-1477
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL202961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice