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Organization
MAINE COAST ORAL SURGERY
Active
Organization
MAINE COAST ORAL SURGERY
Active
Other names
Portland Oral & Maxillofacial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL J COLLETT DDS (ORAL SURGEON)
(207) 772-8055
Entity
Organization
Contact information
Practice address
1601 CONGRESS ST, PORTLAND, ME 04102-2102
(207) 772-8055
(207) 772-8752
Mailing address
1601 CONGRESS ST, PORTLAND, ME 04102-2102
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
NULL
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0008X
Oral and Maxillofacial Radiology Dentistry
—
NULL
1223X0008X
Oral and Maxillofacial Radiology Dentistry
—
—
Other
Enumeration date
07/09/2014
Last updated
03/17/2018
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