Provider Demographics
NPI:1073047973
Name:COLLADO, REBECA MARIA (RDH)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:MARIA
Last Name:COLLADO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2902
Mailing Address - Country:US
Mailing Address - Phone:203-977-4846
Mailing Address - Fax:
Practice Address - Street 1:19 HORTON ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-6216
Practice Address - Country:US
Practice Address - Phone:203-977-6691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008504124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist