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General NPI Number Information
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NPI Number | 1336803600
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Entity Type | Organization
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Legal Business Name | SHOREWOOD FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 10/23/2021
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Last Update Date | 10/23/2021
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Provider Practice Location Address
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Address Line | 3970 N OAKLAND AVE STE 702
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City | SHOREWOOD
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State | WI
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Zip | 53211-2265
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Country | US
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Telephone | 414-332-8150
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Fax | 414-332-6202
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Provider Business Mailing Address
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Address Line | 3970 N OAKLAND AVE STE 702
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City | SHOREWOOD
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State | WI
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Zip | 53211-2265
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Country | US
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Telephone | 414-332-8150
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Fax | 414-332-6202
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Authorized Official
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Title or Position | OWNER MEMBER DENTIST
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Name | DR. PETER JAMES COLOSIMO
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Credential | DDS
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Telephone | 414-526-3271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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