MEDICARE: MAUREEN L. COLELLA DMD

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	122300000X	Dentist	DN18129	MA

General Provider Information

NPI Number	:	1538702261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN L. COLELLA DMD

Provider Business Mailing Address
First Line	:	73 MOUNCE FARM WAY
Second Line	:
City	:	MARSHFIELD
State	:	MA
Zip	:	02050
Country	:	US
Telephone Number	:	781-337-4041
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 UNION ST.
Second Line	:
City	:	SO. WEYMOUTH
State	:	MA
Zip	:	02190
Country	:	US
Telephone Number	:	781-337-4041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	03/19/2020

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