# COLORADO DENTAL SPECIALIST PRACTICE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Colorado Oral Surgery Group, Colorado Endodontic Group, Discovery Kids Pediatric Dentistry, All Smiles Orthodontics, Colorado Dental Specialists, Colorado Orthodontic Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750727285
- **Authorized official:** MICHELLE JOHNSON (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (509) 315-8338

## Contact information

- **Practice address:** 6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
- **Practice address phone:** (719) 427-6390
- **Mailing address:** 6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
- **Mailing address phone:** (719) 266-2717

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 05/10/2013
- **Last updated:** 07/31/2019