Provider Demographics
NPI:1801455456
Name:CANEPA, COLT HARRISON (DMD)
Entity type:Individual
Prefix:
First Name:COLT
Middle Name:HARRISON
Last Name:CANEPA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10926 SE DEER MOSS TRL
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-8130
Mailing Address - Country:US
Mailing Address - Phone:772-418-7864
Mailing Address - Fax:
Practice Address - Street 1:710 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4752
Practice Address - Country:US
Practice Address - Phone:772-334-4090
Practice Address - Fax:772-334-4837
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN241191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice