Provider Demographics
NPI:1033369749
Name:COLLETTE, DAVID C (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:COLLETTE
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10020 IRBID RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3333
Mailing Address - Country:US
Mailing Address - Phone:216-650-7500
Mailing Address - Fax:505-293-9461
Practice Address - Street 1:8310 PALOMAS AVE NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5286
Practice Address - Country:US
Practice Address - Phone:505-294-6009
Practice Address - Fax:505-293-9461
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD39031223S0112X
OH30.0230071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery