Provider Demographics
NPI:1952521098
Name:COLOSIMO, PETER P (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:P
Last Name:COLOSIMO
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 1:3970 N OAKLAND AVE
Mailing Address - Street 2:#702
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211
Mailing Address - Country:US
Mailing Address - Phone:414-332-8150
Mailing Address - Fax:414-332-6202
Practice Address - Street 1:3970 N OAKLAND AVE
Practice Address - Street 2:#702
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211
Practice Address - Country:US
Practice Address - Phone:414-332-8150
Practice Address - Fax:414-332-6202
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000888015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist