Provider Demographics
NPI:1770839219
Name:COLAO, EMILY GILSTRAP (DMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:GILSTRAP
Last Name:COLAO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:DIANE
Other - Last Name:GILSTRAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2801 WADE HAMPTON BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687
Mailing Address - Country:US
Mailing Address - Phone:864-292-6050
Mailing Address - Fax:
Practice Address - Street 1:2801 WADE HAMPTON BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687
Practice Address - Country:US
Practice Address - Phone:864-292-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC80611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice