Healthcare Provider Details

I. General information

NPI: 1033527239
Provider Name (Legal Business Name): RYAN COELLO DMD, MS, FACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S DIXIE HWY STE 103
BOCA RATON FL
33432-7406
US

IV. Provider business mailing address

1700 S DIXIE HWY STE 103
BOCA RATON FL
33432-7406
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 20705
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN20705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: