Anthony Joseph Coletta, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5970-015 Issued in WI

Practice address

11711 W Burleigh St
Wauwatosa, WI 53222-3108

Phone

(414) 771-2345

NPI assigned

Aug 14, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609889187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1064 WHITEWATER LN",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605400377",
            "telephone_number": "630-428-3778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11711 W BURLEIGH ST",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532223108",
            "telephone_number": "414-771-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLETTA",
        "first_name": "ANTHONY",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5970-015",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "0199921",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33798600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Frances Clouse, PHARMD
• CMM Sundaram MD SC
• Sue Anne Cochrane, LCSW
• Melissa Katherine Cody, ACNP-BC
• Ashley Colebourne
• Bethany Ann Collins
• Neaokia Collins
• Stephanie M Collins, APSW
• Taylor Collins
• Communication and Feeding Specialists LLC

• General Practice Dentistry in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.