Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30.023007 | OH |
NPI | 1033369749 |
---|---|
Provider Name | Dr. David C Collette |
First Address | Albuquerque, NM 87122-3333 |
Second Address | Albuquerque, NM 87111-3465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 23/05/2013 |