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General NPI Number Information
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NPI Number | 1114158136
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Entity Type | Individual
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Provider Name | DAN CRISTIAN COLOSI DDS, PHD
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Gender | Male
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Dates
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Enumeration Date | 08/07/2009
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Last Update Date | 08/07/2009
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Provider Practice Location Address
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Address Line | STONY BROOK UNIVERSITY SCHOOL OF SULLIVAN HALL-DENTAL CARE CENTER
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City | STONY BROOK
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State | NY
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Zip | 11794-8700
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Country | US
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Telephone | 631-632-8974
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Fax |
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Provider Business Mailing Address
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Address Line | STONY BROOK UNIVERSITY SCHOOL OF 124 WESTCHESTER HALL
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City | STONY BROOK
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State | NY
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Zip | 11794-8700
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Country | US
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Telephone | 631-632-8925
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Fax | 631-632-3001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 000003
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number | 000003
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License Number State | NY
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