Provider Demographics
NPI:1861669905
Name:COLLARD, KRISTIN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:J
Last Name:COLLARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PROFESSIONAL CTR STE 206
Mailing Address - Street 2:2100 NORTH MAIN STREET
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1882
Mailing Address - Country:US
Mailing Address - Phone:219-663-9500
Mailing Address - Fax:219-663-9595
Practice Address - Street 1:1 PROFESSIONAL CTR STE 206
Practice Address - Street 2:2100 NORTH MAIN STREET
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1882
Practice Address - Country:US
Practice Address - Phone:219-663-9500
Practice Address - Fax:219-663-9595
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011034A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist