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Organization
WISDOM4DENTAL
Active
Organization
WISDOM4DENTAL
Active
Other names
Valladares Colasse Dental Partnership
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIPPE ANDRE COLASSE (OFFICE MANAGER)
(702) 300-0813
Entity
Organization
Contact information
Practice address
1791 MARLOW RD, SUITE 1-D, SANTA ROSA, CA 95401-4151
(702) 300-0813
Mailing address
1791 MARLOW RD, SUITE 1-D, SANTA ROSA, CA 95401-4151
(702) 300-0813
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
61011
CA
1223G0001X
General Practice Dentistry
Primary
61066
CA
Other
Enumeration date
09/14/2015
Last updated
09/14/2015
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