Doctor Name: | DR. RYAN P COLOSI |
NPI Number: | 1437485430 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DDS |
License Number: | 22DI02404900 |
Business Practice Address: | 5829 Phyliss Ln Mint Hill, NC - 282279031 |
Business Phone Number: | 7164456530 |
Business Fax Number: | |
Mailing Address: | Po Box 5037, LAKE WYLIE |
State: | SC |
Postal Code: | 297105001 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/26/2009 |
NPI Last Update Date: | 02/15/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 22DI02404900 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NJ |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |