Provider Demographics
NPI:1639279946
Name:COLACO, MANUEL F (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:F
Last Name:COLACO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 SMITH ROAD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333
Mailing Address - Country:US
Mailing Address - Phone:330-668-4044
Mailing Address - Fax:330-668-4054
Practice Address - Street 1:3045 SMITH ROAD
Practice Address - Street 2:SUITE 600
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333
Practice Address - Country:US
Practice Address - Phone:330-668-4044
Practice Address - Fax:330-668-4054
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH206601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics