Healthcare Provider Details

I. General information

NPI: 1144285222
Provider Name (Legal Business Name): ROSANNE PATRICE COLUCCIO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 ALBANY SHAKER RD STE 201
LOUDONVILLE NY
12211-1970
US

IV. Provider business mailing address

399 ALBANY SHAKER RD STE 201
LOUDONVILLE NY
12211-1970
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-1131
  • Fax: 518-438-9490
Mailing address:
  • Phone: 518-438-1131
  • Fax: 518-438-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number061028
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: