Healthcare Provider Details

I. General information

NPI: 1326972738
Provider Name (Legal Business Name): JOSEPH ROBERT COLLETTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 113TH ST
SEMINOLE FL
33772-2800
US

IV. Provider business mailing address

115 W NORTHVIEW AVE
PHOENIX AZ
85021-8733
US

V. Phone/Fax

Practice location:
  • Phone: 727-893-5050
  • Fax: 727-893-5051
Mailing address:
  • Phone: 602-653-0632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: