Vincent Colasurdo, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10138 Issued in OR

Practice address

833 SW 11TH Ave
Suite 723
Portland, OR 97205-2125

Phone

(503) 223-7661

NPI assigned

Sep 1, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Colasurdodmd LLC

  • General Practice Dentistry
  • Portland, OR
  • NPI 1275259418
  NPD Authorized official
• John G. Colasurdo D.M.D

  • Dentist
  • Portland, OR
  • NPI 1427452085
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409529600000",
    "number": "1013317676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 SW 11TH AVE",
            "address_2": "SUITE 723",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052125",
            "telephone_number": "503-223-7661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 SW 11TH AVE",
            "address_2": "SUITE 723",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052125",
            "telephone_number": "503-223-7661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLASURDO",
        "first_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-01",
        "last_updated": "2014-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D10138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Rose Colagiovanni Morrison
• Christopher Colasurdo, DO, MPH
• John Gabriel Colasurdo, DMD
• Marco Colasurdo
• Melissa Kay Colasurdo, DMD
• Colasurdodmd LLC
• Estefania Colazo
• Isabella Raven Colbert
• Jewell Colbert
• Natalie Marie Colbert

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.