Organization
LAKE WYLIE PEDIATRIC DENTISTRY, LLC
Active
Other names
ryan p colosi dds
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PETER COLOSI DDS (MEMBER)
(803) 619-5155
Entity
Organization
Contact information
Practice address
534 NAUTICAL DR., CLOVER, SC 29710-6102
(803) 619-5155
Mailing address
534 NAUTICAL DR, LAKE WYLIE, SC 29710-5001
(803) 619-5155
(803) 619-6575
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
8097
SC
Other
Enumeration date
02/26/2016
Last updated
03/24/2017
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