Provider Demographics
NPI:1679528905
Name:COLLIER, KEVIN BRADLEY (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRADLEY
Last Name:COLLIER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:BRUCKER
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1480 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SEA BRIGHT
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-2226
Mailing Address - Country:US
Mailing Address - Phone:732-530-5566
Mailing Address - Fax:732-530-8625
Practice Address - Street 1:1480 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:SEA BRIGHT
Practice Address - State:NJ
Practice Address - Zip Code:07760-2226
Practice Address - Country:US
Practice Address - Phone:732-530-5566
Practice Address - Fax:732-530-8625
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ135131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice