Organization
PRESTIGE DENTAL LLC
Active
Other names
Prestige Dental Centers
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANA D SHAY (OFFICE MANAGER)
(719) 597-3700
Entity
Organization
Contact information
Practice address
3208 N ACADEMY BLVD STE 110, COLORADO SPRINGS, CO 80917-5171
(719) 597-3700
(719) 597-7507
Mailing address
3208 N ACADEMY BLVD STE 110, COLORADO SPRINGS, CO 80917-5171
(719) 597-3700
(719) 597-7507
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
201875
CO
122300000X
Dentist
Primary
7989
CO
124Q00000X
Dental Hygienist
DH000905418
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38873362
—
CO
05
—
65426061
—
CO
05
—
97401862
—
CO
Enumeration date
10/20/2014
Last updated
10/20/2014
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