Individual provider Active NPI

Colin P Del Rosario, DDS

  • General Practice Dentistry
  • Kirkland, WA
National Provider Identifier
1114918570
Registry record updated Apr 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE00009384 Issued in WA
Practice address
11250 Kirkland Way
Suite 102
Kirkland, WA 98033-3421
Phone
(425) 739-9093
Fax
(425) 822-3677
NPI assigned
Nov 3, 2005
Last updated
Apr 18, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DE00009384 WA Primary

Addresses

Primary practice location

11250 Kirkland Way
Suite 102
Kirkland, WA 98033-3421

Mailing address

11250 Kirkland Way
Suite 102
Kirkland, WA 98033-3421
Phone (425) 739-9093

Other identifiers 3

IdentifierTypeStateIssuer
000000187119OtherDENTAL BENEFIT PROVIDERS
01482576OtherUNITED CONCORDIA
5043096MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DE00009384WAMDGeneral Practice Dentistry

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208476800000",
    "number": "1114918570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11250 KIRKLAND WAY",
            "address_2": "SUITE 102",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980333421",
            "telephone_number": "425-739-9093",
            "fax_number": "425-822-3677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11250 KIRKLAND WAY",
            "address_2": "SUITE 102",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980333421",
            "telephone_number": "425-739-9093",
            "fax_number": "425-822-3677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEL ROSARIO",
        "first_name": "COLIN",
        "middle_name": "P",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2008-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00009384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL BENEFIT PROVIDERS",
            "identifier": "000000187119",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "01482576",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5043096",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.