Organization
COLORADO DENTAL ORTHODONTIST PRACTICE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JOHNSON (CREDENTIALING SPECIALIST)
(509) 315-8338
Entity
Organization
Contact information
Practice address
6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
(719) 266-2717
Mailing address
6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
05/03/2021
Last updated
05/03/2021
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