Organization
COLORADO DENTAL ORTHODONTIST PRACTICE, PLLC
Active
Parent organization
COLORADO DENTAL ORTHODONTIST PRACTICE, PLLC
Other names
South Springs Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLORADO DENTAL ORTHODONTIST PRACTICE, PLLC
Authorized official
MICHELLE JOHNSON (CREDENTIALING SPECIALIST)
(509) 315-8338
Entity
Organization
Contact information
Practice address
6514 S ACADEMY BLVD, COLORADO SPRINGS, CO 80906-8614
(719) 494-0718
Mailing address
6514 S ACADEMY BLVD, COLORADO SPRINGS, CO 80906-8614
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
05/05/2021
Last updated
05/05/2021
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