Provider Demographics
NPI:1033425863
Name:CLATANOFF, COLLIN R (DDS)
Entity type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:R
Last Name:CLATANOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 N 40TH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-9181
Mailing Address - Country:US
Mailing Address - Phone:602-892-9000
Mailing Address - Fax:
Practice Address - Street 1:5050 N 40TH ST STE 160
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:602-892-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7725537-9921122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist