Provider Demographics
NPI:1003838525
Name:COELLO, CARLOS A JR (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:COELLO
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 S DIXIE HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7452
Mailing Address - Country:US
Mailing Address - Phone:561-368-4057
Mailing Address - Fax:561-368-3405
Practice Address - Street 1:1700 S DIXIE HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-7452
Practice Address - Country:US
Practice Address - Phone:561-368-4057
Practice Address - Fax:561-368-3405
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12137332BC3200X
FL00121371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment