Individual
BROCK COLETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3235 N TOWERBRIDGE WAY STE 200, MERIDIAN, ID 83646-5721
(208) 888-7711
(208) 888-3089
Mailing address
3235 N TOWERBRIDGE WAY STE 200, MERIDIAN, ID 83646-5721
(208) 888-7711
(208) 888-3089
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D-4928
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/15/2016
Last updated
11/13/2019
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