Provider Demographics
NPI:1609840800
Name:COLALILLO, ALEX A JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:A
Last Name:COLALILLO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2048
Mailing Address - Country:US
Mailing Address - Phone:856-854-8101
Mailing Address - Fax:856-854-2025
Practice Address - Street 1:993 HADDON AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-2048
Practice Address - Country:US
Practice Address - Phone:856-854-8101
Practice Address - Fax:856-854-2025
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist