Individual
RUSSELL J COLLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1601 CONGRESS STREET, PORTLAND, ME 04102
(207) 772-8055
(207) 772-8752
Mailing address
1601 CONGRESS STREET, PORTLAND, ME 04102
(207) 772-8055
(207) 772-8752
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
3009
ME
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
3009
ME
1223X0008X
Oral and Maxillofacial Radiology Dentistry
3009
ME
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
3009
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221210000
—
ME
Enumeration date
09/13/2006
Last updated
03/17/2018
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