Provider Demographics
NPI:1598546897
Name:COLLADO DENTAL CORP
Entity Type:Organization
Organization Name:COLLADO DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA TEJADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-865-8900
Mailing Address - Street 1:1315 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-7426
Mailing Address - Country:US
Mailing Address - Phone:201-865-8900
Mailing Address - Fax:
Practice Address - Street 1:1315 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-7426
Practice Address - Country:US
Practice Address - Phone:201-865-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty