Provider Demographics
NPI:1710153374
Name:COLAIZZI, LYNDA ROSE
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:ROSE
Last Name:COLAIZZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 MINORCA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3756
Mailing Address - Country:US
Mailing Address - Phone:305-790-3361
Mailing Address - Fax:
Practice Address - Street 1:645 MINORCA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3756
Practice Address - Country:US
Practice Address - Phone:305-790-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist