Provider Demographics
NPI:1972840718
Name:ROSANNE P. COLUCCIO,D.D.S.,PS
Entity Type:Organization
Organization Name:ROSANNE P. COLUCCIO,D.D.S.,PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSANNE
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:COLUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-823-4100
Mailing Address - Street 1:9800 NE 120TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4220
Mailing Address - Country:US
Mailing Address - Phone:425-823-4100
Mailing Address - Fax:425-820-4699
Practice Address - Street 1:9800 NE 120TH PL
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4220
Practice Address - Country:US
Practice Address - Phone:425-823-4100
Practice Address - Fax:425-820-4699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSANNE P. COLUCCIO D.D.S.,PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010054261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental