Provider Demographics
NPI:1245404367
Name:COLIN P. DEL ROSARIO, DDS, PS
Entity Type:Organization
Organization Name:COLIN P. DEL ROSARIO, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEL ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-739-9093
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009384261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5043096Medicaid