Provider Demographics
NPI:1508025255
Name:COLELLA, CHRISTINE M (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:M
Last Name:COLELLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 BOWEN RD
Mailing Address - Street 2:POB 350
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9459
Mailing Address - Country:US
Mailing Address - Phone:716-655-3441
Mailing Address - Fax:716-655-3480
Practice Address - Street 1:2340 BOWEN RD
Practice Address - Street 2:POB 350
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9459
Practice Address - Country:US
Practice Address - Phone:716-655-3441
Practice Address - Fax:716-655-3480
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044770122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist