Provider Demographics
NPI:1083317135
Name:COLAISENO, ALISHA DIANNE
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:DIANNE
Last Name:COLAISENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 HORSE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917-8446
Mailing Address - Country:US
Mailing Address - Phone:304-877-2201
Mailing Address - Fax:
Practice Address - Street 1:177 HORSE CREEK RD
Practice Address - Street 2:
Practice Address - City:SCARBRO
Practice Address - State:WV
Practice Address - Zip Code:25917-8446
Practice Address - Country:US
Practice Address - Phone:304-877-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist