Provider Demographics
NPI:1578233938
Name:KELLIHER, COLIN FRANCIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:FRANCIS
Last Name:KELLIHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 BLANCHAN AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1203
Mailing Address - Country:US
Mailing Address - Phone:708-285-3890
Mailing Address - Fax:
Practice Address - Street 1:1212 BLANCHAN AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526-1203
Practice Address - Country:US
Practice Address - Phone:708-285-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019033416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist