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General NPI Number Information
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NPI Number | 1427210780
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Entity Type | Individual
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Provider Name | JARED RALPH COLLETT DMD, PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | BUILDING 110, 1 JUFFAIR AVENUE NAVAL SUPPORT ACTIVITY BAHRAIN
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City | FPO
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State | AE
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Zip | 09834
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Country | BH
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 851 BOX 340
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City | FPO
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State | AE
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Zip | 09834-0004
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Country | US
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Telephone | 318-439-4211
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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 | D011535
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA60034324
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License Number State | WA
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