Individual
MR. MICHAEL T COLLETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
237 S MAIN ST, LOMBARD, IL 60148-2647
(630) 620-8304
(630) 620-8759
Mailing address
237 S MAIN ST, LOMBARD, IL 60148-2647
(630) 620-8304
(630) 620-8759
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019019118
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019019118
LICENSE NUMBER
IL
Enumeration date
05/20/2008
Last updated
05/20/2008
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