Provider Demographics
NPI:1205041233
Name:COLLINS, REUBEN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:REUBEN
Middle Name:D
Last Name:COLLINS
Suffix:
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 1:1525 E 53RD ST
Mailing Address - Street 2:SUITE 904
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4557
Mailing Address - Country:US
Mailing Address - Phone:773-752-2300
Mailing Address - Fax:773-752-2840
Practice Address - Street 1:1525 E 53RD ST
Practice Address - Street 2:SUITE 904
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4557
Practice Address - Country:US
Practice Address - Phone:773-752-2300
Practice Address - Fax:773-752-2840
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice