Provider Demographics
NPI:1407466162
Name:COLAIZZI, CHRISTA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:A
Last Name:COLAIZZI
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 1:575 PIERCE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5700
Mailing Address - Country:US
Mailing Address - Phone:570-331-8100
Mailing Address - Fax:570-714-8100
Practice Address - Street 1:575 PIERCE ST STE 201
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5700
Practice Address - Country:US
Practice Address - Phone:570-331-8100
Practice Address - Fax:570-714-8100
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042784122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA231870842OtherDENTIST