Provider Demographics
NPI:1396042925
Name:COLON-TORRADO, MARIBEL (DMD)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:COLON-TORRADO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 W LAKE HOUSTON PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-5227
Mailing Address - Country:US
Mailing Address - Phone:281-446-1169
Mailing Address - Fax:281-360-3392
Practice Address - Street 1:2815 W LAKE HOUSTON PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5227
Practice Address - Country:US
Practice Address - Phone:281-446-1169
Practice Address - Fax:281-360-3392
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162747301Medicaid