Provider Demographics
NPI:1922987346
Name:COLLINS, KENNETH THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:THOMAS
Last Name:COLLINS
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 1:5410 S STONE LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-9119
Mailing Address - Country:US
Mailing Address - Phone:509-990-5003
Mailing Address - Fax:
Practice Address - Street 1:3151 E 28TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4922
Practice Address - Country:US
Practice Address - Phone:509-532-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA700003461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice