NPI Profile for RUSSELL J COLLETT in PORTLAND, ME.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery | |
Oral and Maxillofacial Pathology |
1223P0106X | |||
Oral and Maxillofacial Radiology |
1223X0008X | |||
Oral and Maxillofacial Surgery |
1223S0112X | 19 | Oral Surgery (Dentist only) |
| NPI # | 1629173711 |
|
| Status | Active | |
| Credentials | DDS (Doctor of Dental Surgery) | |
| Entity | Individual | |
| Enumeration date | 09/13/2006 | |
| Last updated | 03/17/2018 - About 8 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
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|
| Hospital affiliation(s) | Not Available |
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RUSSELL J COLLETT
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