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LAKE WYLIE PEDIATRIC DENTISTRY LLC NPI 1528428091


NPI Information

NPI: 1528428091
Provider Name: LAKE WYLIE PEDIATRIC DENTISTRY, LLC

Other Name: RYAN P COLOSI DDS

Classification: Dentist - 1223P0221X
Entity Type: Organization

Specialization: Pediatric Dentistry

Address:
534 NAUTICAL DR.
CLOVER, SC
ZIP 29710
Phone: (803) 619-5155
Get Directions

LAKE WYLIE PEDIATRIC DENTISTRY, LLC is a pediatric dentistry dentist in Clover, SC. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. LAKE WYLIE PEDIATRIC DENTISTRY, LLC NPI is 1528428091. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Ryan P Colosi Dds.

The provider's business location address is:

534 NAUTICAL DR.
CLOVER, SC
ZIP 29710-102
Phone: (803) 619-5155

The provider's authorized official is Ryan Peter Colosi .
The authorized official title is Member and has the following contact phone number (803) 619-5155.

The enumeration date for this NPI number is 2/26/2016 and was last updated on 3/24/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0221XDentistPediatric Dentistry8097SOUTH CAROLINAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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