# COLORADO DENTAL SPECIALIST PRACTICE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COLORADO DENTAL SPECIALIST PRACTICE, LLC
- **Other names:** Colorado Oral Surgery Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1740834381
- **Legal business name:** COLORADO DENTAL SPECIALIST PRACTICE, LLC
- **Authorized official:** MICHELLE JOHNSON (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (509) 315-8338

## Contact information

- **Practice address:** 1005 W 120TH AVE STE 800, WESTMINSTER, CO 80234-2747
- **Practice address phone:** (720) 263-5420
- **Mailing address:** 1005 W 120TH AVE STE 800, WESTMINSTER, CO 80234-2747
- **Mailing address phone:** (720) 263-5420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 07/31/2019
- **Last updated:** 07/31/2019