Provider Demographics
NPI:1346232667
Name:MASILLAMONI, COLLET R (DDS)
Entity type:Individual
Prefix:DR
First Name:COLLET
Middle Name:R
Last Name:MASILLAMONI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8547
Mailing Address - Country:US
Mailing Address - Phone:928-782-4369
Mailing Address - Fax:
Practice Address - Street 1:240 E 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8547
Practice Address - Country:US
Practice Address - Phone:928-782-4369
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist