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NPI Code Detail

MEDICARE: SERENA M COLLETTI DDS

MEDICARE: SERENA M COLLETTI DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223E0200XEndodonticsDS025942LPA

General Provider Information

NPI Number : 1306914155
Entity Type Code : Individual
Provider Name (Legal Business Name) : SERENA M COLLETTI DDS
Provider Business Mailing Address
First Line : 240 GEIGER RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-1008
Country : US
Telephone Number : 610-405-1768
Fax Number :
Provider Business Practice Location Address
First Line : 240 GEIGER RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-1008
Country : US
Telephone Number : 610-405-1768
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2006
Last Update Date : 12/11/2012

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Directions to “ SERENA M COLLETTI DDS” Practice Location

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