Healthcare Provider Details

I. General information

NPI: 1649101262
Provider Name (Legal Business Name): MICHELA MARIE COLAVITA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 MOUNTAIN VIEW AVE
LONGMONT CO
80501-3253
US

IV. Provider business mailing address

5788 BEELER CT
DENVER CO
80238-3999
US

V. Phone/Fax

Practice location:
  • Phone: 970-239-1514
  • Fax:
Mailing address:
  • Phone: 610-733-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00206675
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: