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Organization
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Active
Organization
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JOHNSON (CREDENTIALING SPECIALIST)
(509) 315-8338
Entity
Organization
Contact information
Practice address
2721 W 120TH AVE STE 200, WESTMINSTER, CO 80234-2946
(303) 586-6985
(719) 213-2311
Mailing address
6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
12/05/2018
Last updated
12/05/2018
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