Healthcare Provider Details

I. General information

NPI: 1750751038
Provider Name (Legal Business Name): CARLOS A COELLO DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S DIXIE HWY SUITE 103
BOCA RATON FL
33432-7452
US

IV. Provider business mailing address

1700 S DIXIE HWY SUITE 103
BOCA RATON FL
33432-7452
US

V. Phone/Fax

Practice location:
  • Phone: 561-368-4057
  • Fax: 561-368-3405
Mailing address:
  • Phone: 561-368-4057
  • Fax: 561-368-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN12137
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS A. COELLO
Title or Position: OWNER
Credential: DMD
Phone: 561-368-4057