Provider Demographics
NPI:1831809094
Name:COLETTI DENTAL LLC
Entity type:Organization
Organization Name:COLETTI DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:COLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-888-2427
Mailing Address - Street 1:115 LAKEVIEW TER
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-0869
Mailing Address - Country:US
Mailing Address - Phone:781-888-2427
Mailing Address - Fax:
Practice Address - Street 1:922 WALTHAM ST STE 210
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8019
Practice Address - Country:US
Practice Address - Phone:781-862-8662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty