Provider Demographics
NPI:1316045339
Name:COLLETTA, SALVATORE (DMD)
Entity type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:
Last Name:COLLETTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 ALLDS ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-4758
Mailing Address - Country:US
Mailing Address - Phone:603-882-3727
Mailing Address - Fax:603-886-3950
Practice Address - Street 1:76 ALLDS ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-4758
Practice Address - Country:US
Practice Address - Phone:603-882-3727
Practice Address - Fax:603-886-3950
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH31001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAFC8204694OtherDEA NUMBER
NHBC3287011OtherDEA NUMBER