Provider Demographics
NPI:1114158136
Name:COLOSI, DAN CRISTIAN (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:CRISTIAN
Last Name:COLOSI
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STONY BROOK UNIVERSITY SCHOOL OF
Mailing Address - Street 2:124 WESTCHESTER HALL
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8700
Mailing Address - Country:US
Mailing Address - Phone:631-632-8925
Mailing Address - Fax:631-632-3001
Practice Address - Street 1:STONY BROOK UNIVERSITY SCHOOL OF
Practice Address - Street 2:SULLIVAN HALL-DENTAL CARE CENTER
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8700
Practice Address - Country:US
Practice Address - Phone:631-632-8974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000003122300000X, 1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No122300000XDental ProvidersDentist