Provider Demographics
NPI:1033300421
Name:COLLETTI, LAURENCE J (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:J
Last Name:COLLETTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:660 BANNOCK ST # L
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4506
Mailing Address - Country:US
Mailing Address - Phone:303-602-8200
Mailing Address - Fax:303-602-4560
Practice Address - Street 1:660 BANNOCK ST # L
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4506
Practice Address - Country:US
Practice Address - Phone:303-602-8200
Practice Address - Fax:303-602-4560
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.000063651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics