Provider Demographics
NPI:1174742647
Name:CANDACE R COLELLA DMD PA
Entity type:Organization
Organization Name:CANDACE R COLELLA DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-428-6923
Mailing Address - Street 1:4690 N STATE ROAD 7 STE 201
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3904
Mailing Address - Country:US
Mailing Address - Phone:954-428-6923
Mailing Address - Fax:954-531-1634
Practice Address - Street 1:4690 N STATE RD. 7
Practice Address - Street 2:SUITE 201
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3904
Practice Address - Country:US
Practice Address - Phone:954-428-6923
Practice Address - Fax:954-531-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00147241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFLORIDA COMBINED LIFE
FL=========OtherMETLIFE
FL=========OtherUNITED CONCORDIA
FL=========OtherDELTA DENTAL
FL=========OtherCIGNA
FL=========OtherAETNA
FL=========OtherGUARDIAN
FL=========OtherBLUE CROSS BLUE SHIELD
FL=========OtherFORTIS
FL=========OtherHUMANA