MEDICARE: JUAN COLLADO, DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	045828-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518172113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUAN COLLADO, DDS PC

Provider Business Mailing Address
First Line	:	365 ROCKLEDGE PL
Second Line	:	PRIVATE HOUSE
City	:	TEANECK
State	:	NJ
Zip	:	07666-4014
Country	:	US
Telephone Number	:	212-568-3231
Fax Number	:	212-568-7727

Provider Business Practice Location Address
First Line	:	520 W 190TH ST
Second Line	:	SUITE A
City	:	NEW YORK
State	:	NY
Zip	:	10040-3407
Country	:	US
Telephone Number	:	212-568-3231
Fax Number	:	212-568-7727

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JUAN PABLO COLLADO
Credential	:	D.D.S.
Telephone Number	:	212-568-3231

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/22/2020

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