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General NPI Number Information
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NPI Number | 1144948746
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Entity Type | Individual
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Provider Name | JAY COLUCCI DDS
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Gender | Male
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 820 S NORTHWEST HWY
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City | BARRINGTON
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State | IL
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Zip | 60010-4622
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Country | US
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Telephone | 847-381-3927
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 BRIGHTON DR
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City | CAROL STREAM
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State | IL
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Zip | 60188-4327
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Country | US
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Telephone | 630-917-4600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.033936
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License Number State | IL
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