MEDICARE: DR. ALEX A. COLALILLO JR. D.D.S.

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	12584	NJ

General Provider Information

NPI Number	:	1609840800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEX A. COLALILLO JR. D.D.S.

Provider Business Mailing Address
First Line	:	993 HADDON AVE
Second Line	:
City	:	COLLINGSWOOD
State	:	NJ
Zip	:	08108-2048
Country	:	US
Telephone Number	:	856-854-8101
Fax Number	:	856-854-2025

Provider Business Practice Location Address
First Line	:	993 HADDON AVE
Second Line	:
City	:	COLLINGSWOOD
State	:	NJ
Zip	:	08108-2048
Country	:	US
Telephone Number	:	856-854-8101
Fax Number	:	856-854-2025

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/08/2007

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