Healthcare Provider Details

I. General information

NPI: 1033300421
Provider Name (Legal Business Name): LAURENCE J. COLLETTI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 BANNOCK ST # L
DENVER CO
80204-4506
US

IV. Provider business mailing address

660 BANNOCK ST # L
DENVER CO
80204-4506
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-8200
  • Fax: 303-602-4560
Mailing address:
  • Phone: 303-602-8200
  • Fax: 303-602-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN.00006365
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: