Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 6365 | CO |
NPI | 1033300421 |
---|---|
Provider Name | Dr. Laurence J. Colletti |
First Address | Louisville, CO 80027-9460 |
Second Address | Louisville, CO 80027-9460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 09/08/2007 |