Healthcare Provider Details

I. General information

NPI: 1033369749
Provider Name (Legal Business Name): DAVID C COLLETTE DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 PALOMAS AVE NE STE B
ALBUQUERQUE NM
87109-5286
US

IV. Provider business mailing address

10020 IRBID RD NE
ALBUQUERQUE NM
87122-3333
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-6009
  • Fax: 505-293-9461
Mailing address:
  • Phone: 216-650-7500
  • Fax: 505-293-9461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDD3903
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: