Provider Demographics
NPI:1467808592
Name:COLOSIMO, ALEXIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:COLOSIMO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:BELISLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11035 W FOREST HOME AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11035 W FOREST HOME AVE STE 116
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2541
Practice Address - Country:US
Practice Address - Phone:414-529-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1000975-151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry