Provider Demographics
NPI:1447372578
Name:COLLINS, KEVIN JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOSEPH
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 1:6619 AIRLINE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-5169
Mailing Address - Country:US
Mailing Address - Phone:504-733-0484
Mailing Address - Fax:504-733-0326
Practice Address - Street 1:6619 AIRLINE DR
Practice Address - Street 2:SUITE B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-5169
Practice Address - Country:US
Practice Address - Phone:504-733-0484
Practice Address - Fax:504-733-0326
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA42641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1842648Medicaid