Provider Demographics
NPI:1518074202
Name:COLLINS, JEFFREY K (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:K
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 1:105 E FIRST STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:630-789-8070
Mailing Address - Fax:630-789-8071
Practice Address - Street 1:105 E FIRST STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-789-8070
Practice Address - Fax:630-789-8071
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
K27346Medicare ID - Type Unspecified
K27348Medicare ID - Type Unspecified
K27347Medicare ID - Type Unspecified
V09059Medicare UPIN
K27345Medicare ID - Type Unspecified