Provider Demographics
NPI:1538702261
Name:COLELLA, MAUREEN L (DMD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:L
Last Name:COLELLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:L
Other - Last Name:CATAUDELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:73 MOUNCE FARM WAY
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050
Mailing Address - Country:US
Mailing Address - Phone:781-337-4041
Mailing Address - Fax:
Practice Address - Street 1:33 UNION ST.
Practice Address - Street 2:
Practice Address - City:SO. WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190
Practice Address - Country:US
Practice Address - Phone:781-337-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist