Collett, Russell J
Collett, Russell J is an sole proprietor health care provider with primary practice located at 1601 Congress Street , Portland ME 04102. He recently has 4 registered licenses in different health care specialties including Dental Providers / Oral and Maxillofacial Pathology, Dental Providers / Oral and Maxillofacial Surgery, Dental Providers / Oral and Maxillofacial Radiology, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery is his primary health care specialty. Collett, Russell J can be contacted via phone (207) 772-8055.Contact Information
Primary practice address
1601 Congress Street
Portland ME 04102
Phone: (207) 772-8055
Fax: (207) 772-8752
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Pathology | 1223P0106X | 3009 | Maine |
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 3009 | Maine |
| Dental Providers / Oral and Maxillofacial Radiology | 1223X0008X | 3009 | Maine |
| Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery | 204E00000X | 3009 | Maine |
Profile Details
| NPI number | 1629173711 |
|---|---|
| LBN Legal business name | Collett, Russell J |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 13th, 2006 |
| Last updated | Mar 17th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629173711 | NPPES |
| Maine | MEDICAID | 221210000 |
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