Provider Demographics
NPI:1114062593
Name:COLLINS, KENNETH J JR (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6222 E 25TH LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-2301
Mailing Address - Country:US
Mailing Address - Phone:509-443-1327
Mailing Address - Fax:509-532-1141
Practice Address - Street 1:3151 E 28TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4922
Practice Address - Country:US
Practice Address - Phone:509-532-1111
Practice Address - Fax:509-532-1141
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA81051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice