Provider Demographics
NPI:1861713109
Name:JEFFREY M. COLLURA, DMD, PC
Entity type:Organization
Organization Name:JEFFREY M. COLLURA, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COLLURA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-774-6553
Mailing Address - Street 1:7 BURNHAM ST
Mailing Address - Street 2:
Mailing Address - City:TURNERS FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01376-1841
Mailing Address - Country:US
Mailing Address - Phone:413-774-6553
Mailing Address - Fax:413-773-9502
Practice Address - Street 1:7 BURNHAM ST
Practice Address - Street 2:
Practice Address - City:TURNERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01376-1841
Practice Address - Country:US
Practice Address - Phone:413-774-6553
Practice Address - Fax:413-773-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855353261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental