Provider Demographics
NPI:1598533762
Name:COLT CANEPA DMD LLC
Entity Type:Organization
Organization Name:COLT CANEPA DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:COLT
Authorized Official - Middle Name:
Authorized Official - Last Name:CANEPA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:772-418-7864
Mailing Address - Street 1:10926 SE DEER MOSS TRL
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33469-8130
Mailing Address - Country:US
Mailing Address - Phone:772-418-7864
Mailing Address - Fax:
Practice Address - Street 1:710 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4752
Practice Address - Country:US
Practice Address - Phone:772-334-4090
Practice Address - Fax:772-334-4837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty