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RUSSELL J COLLETT DDS NPI 1629173711


NPI Information

NPI: 1629173711
Provider Name: RUSSELL J COLLETT, DDS
Classification: Oral & Maxillofacial Surgery - 204E00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
1601 CONGRESS STREET
PORTLAND, ME
ZIP 04102
Phone: (207) 772-8055
Get Directions

Russell J Collett, DDS is an oral maxillofacial surgery in Portland, ME. The provider is oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. Russell J Collett, DDS NPI is 1629173711. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1601 CONGRESS STREET
PORTLAND, ME
ZIP 04102
Phone: (207) 772-8055
Fax: (207) 772-8752

The NPI 1629173711 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 9/13/2006 and was last updated on 3/17/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223P0106XDentistOral and Maxillofacial Pathology3009MAINENo
21223S0112XDentistOral and Maxillofacial Surgery3009MAINENo
31223X0008XDentistOral and Maxillofacial Radiology3009MAINENo
4204E00000XOral & Maxillofacial Surgery3009MAINEYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1221210000MEDICAIDMAINE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.