Provider Demographics
NPI:1255595625
Name:COLLURA, JOSEPH JOHN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:COLLURA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 N CAUSEWAY BLVD
Mailing Address - Street 2:STE #104
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-1779
Mailing Address - Country:US
Mailing Address - Phone:504-837-9800
Mailing Address - Fax:504-828-9809
Practice Address - Street 1:3939 N CAUSEWAY BLVD
Practice Address - Street 2:STE #104
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1779
Practice Address - Country:US
Practice Address - Phone:504-837-9800
Practice Address - Fax:504-828-9809
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice