Provider Demographics
NPI:1275950750
Name:ORELLANA, COLLEEN CLAIRE (DDS)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:CLAIRE
Last Name:ORELLANA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:CLAIRE
Other - Last Name:HEFFERNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:45 CLAIREDAN DR
Mailing Address - Street 2:OLENTANGY PEDIATRIC DENTISTRY
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8064
Mailing Address - Country:US
Mailing Address - Phone:614-433-7474
Mailing Address - Fax:614-722-6791
Practice Address - Street 1:45 CLAIREDAN DR.
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-2654
Practice Address - Country:US
Practice Address - Phone:614-433-7474
Practice Address - Fax:614-433-9090
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300242231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0128017Medicaid