Individual
DR. CHRISTOPHER KOLLATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3612 S CLARK ST, MEXICO, MO 65265-4104
(573) 581-4352
Mailing address
3612 S CLARK ST, MEXICO, MO 65265-4104
(573) 581-4352
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2021023768
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021023768
MO DENTAL BOARD, DENTAL LICENSE
MO
Enumeration date
06/30/2021
Last updated
06/30/2021
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