Provider Demographics
NPI:1033527239
Name:COELLO, RYAN (DMD, MS, FACP)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:COELLO
Suffix:
Gender:M
Credentials:DMD, MS, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S DIXIE HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7406
Mailing Address - Country:US
Mailing Address - Phone:561-368-4057
Mailing Address - Fax:
Practice Address - Street 1:1700 S DIXIE HWY STE 103
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-7406
Practice Address - Country:US
Practice Address - Phone:561-368-4057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20705122300000X
FLDN207051223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist