Provider Demographics
NPI:1497934186
Name:COLOSI, RUSSELL PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:PETER
Last Name:COLOSI
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 1:1348 EAST RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2743
Mailing Address - Country:US
Mailing Address - Phone:716-773-7682
Mailing Address - Fax:716-773-9735
Practice Address - Street 1:1348 EAST RIVER ROAD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2743
Practice Address - Country:US
Practice Address - Phone:716-773-7682
Practice Address - Fax:716-773-9735
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0338711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice