Active NPI
Katelyn Collelo, DDS
- General Practice Dentistry
- Wausau, WI
National Provider Identifier
1992379457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1002598-15
- Practice address
- 227071 Hummingbird Rd
Wausau, WI 54401-3332 - Phone
- (715) 845-3200
- NPI assigned
- May 18, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1002598-15 | WI | Primary |
Addresses
Primary practice location
227071 Hummingbird Rd
Wausau, WI 54401-3332
Mailing address
3325 N 12TH St
Wausau, WI 54403-2315
Phone (715) 297-1209
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1002598-15 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Szmanda Dental Center, SC | General Practice | Current | Accepting new patients |
Locations
227071 Hummingbird Rd
Rib Mountain, WI 54401
Phone (715) 845-3200
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625443200000",
"number": "1992379457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3325 N 12TH ST",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544032315",
"telephone_number": "715-297-1209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "227071 HUMMINGBIRD RD",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544013332",
"telephone_number": "715-845-3200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLELO",
"first_name": "KATELYN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-18",
"last_updated": "2021-07-05",
"certification_date": "2021-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "1002598-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.