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General NPI Number Information
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NPI Number | 1639133978
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Entity Type | Individual
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Provider Name | VINCENT COLOSIMO DMD
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Gender | Male
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 2811 N GREEN VALLEY PKWY
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City | HENDERSON
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State | NV
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Zip | 89014-0401
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Country | US
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Telephone | 702-434-2219
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Fax | 702-456-6160
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Provider Business Mailing Address
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Address Line | 926 GREAT POND DR SUITE 2003
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-7244
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Country | US
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Telephone | 407-772-5124
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Fax | 407-788-3572
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4547T
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License Number State | NV
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