Provider Demographics
NPI:1114918570
Name:DEL ROSARIO, COLIN P (DDS)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:P
Last Name:DEL ROSARIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 KIRKLAND WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-3421
Mailing Address - Country:US
Mailing Address - Phone:425-739-9093
Mailing Address - Fax:425-822-3677
Practice Address - Street 1:11250 KIRKLAND WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-3421
Practice Address - Country:US
Practice Address - Phone:425-739-9093
Practice Address - Fax:425-822-3677
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000093841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
01482576OtherUNITED CONCORDIA
WA5043096Medicaid
000000187119OtherDENTAL BENEFIT PROVIDERS