Provider Demographics
NPI:1558571919
Name:COLANDREA, KATHERINE ROSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ROSE
Last Name:COLANDREA
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 1:810 OLD MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1522
Mailing Address - Country:US
Mailing Address - Phone:860-721-8382
Mailing Address - Fax:
Practice Address - Street 1:810 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1522
Practice Address - Country:US
Practice Address - Phone:860-721-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT96221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice