Provider Demographics
NPI:1972927374
Name:ANELLO, CAROLYN KAY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:KAY
Last Name:ANELLO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 ELMIRA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-2122
Mailing Address - Country:US
Mailing Address - Phone:720-460-0995
Mailing Address - Fax:877-434-7701
Practice Address - Street 1:1666 ELMIRA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-2122
Practice Address - Country:US
Practice Address - Phone:720-460-0995
Practice Address - Fax:877-434-7701
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905629124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49580523Medicaid