Provider Demographics
NPI:1306825401
Name:COLLIER, KIRK C (DDS)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:C
Last Name:COLLIER
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:PO BOX 411863
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1863
Mailing Address - Country:US
Mailing Address - Phone:913-579-9025
Mailing Address - Fax:
Practice Address - Street 1:3700 W 83RD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5121
Practice Address - Country:US
Practice Address - Phone:913-381-5194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55301223S0112X
MO0130931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4803373206OtherFED TAX ID