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General NPI Number Information
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NPI Number | 1174742647
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Entity Type | Organization
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Legal Business Name | CANDACE R COLELLA DMD PA
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 4690 N STATE RD. 7 SUITE 201
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3904
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Country | US
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Telephone | 954-428-6923
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Fax | 954-531-1634
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Provider Business Mailing Address
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Address Line | 4690 N STATE ROAD 7 STE 201
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City | CORAL SPRINGS
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State | FL
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Zip | 33073-3904
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Country | US
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Telephone | 954-428-6923
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Fax | 954-531-1634
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | CANDACE R COLELLA
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Credential | DMD
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Telephone | 954-428-6923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN0014724
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License Number State | FL
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