Provider Demographics
NPI:1477717262
Name:DRS COLASANTO AND MONFARED PC
Entity Type:Organization
Organization Name:DRS COLASANTO AND MONFARED PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLASANTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-525-7471
Mailing Address - Street 1:3801 N FAIRFAX DR
Mailing Address - Street 2:# 51
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3801 N FAIRFAX DR
Practice Address - Street 2:# 51
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1702
Practice Address - Country:US
Practice Address - Phone:703-525-7471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010076701223E0200X
VA04010071461223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty