Provider Demographics
NPI:1497809222
Name:DRS. KOLLMAN & FURUSHO, DENTISTRY FOR KIDS, LTD.
Entity Type:Organization
Organization Name:DRS. KOLLMAN & FURUSHO, DENTISTRY FOR KIDS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-545-0007
Mailing Address - Street 1:4801 W PETERSON AVE
Mailing Address - Street 2:STE. 410
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5713
Mailing Address - Country:US
Mailing Address - Phone:773-545-0007
Mailing Address - Fax:
Practice Address - Street 1:4801 W PETERSON AVE
Practice Address - Street 2:STE. 410
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5713
Practice Address - Country:US
Practice Address - Phone:773-545-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty