Organization
FRONT RANGE PEDIATRIC DENTISTRY, PLLC
Active
Other names
Cool Mountain Kids Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK MILLER DDS (OWNER)
(719) 550-1010
Entity
Organization
Contact information
Practice address
6160 TUTT BLVD, SUITE 140, COLORADO SPRINGS, CO 80923-3500
(719) 550-1010
(719) 550-1212
Mailing address
6160 TUTT BLVD, SUITE 140, COLORADO SPRINGS, CO 80923-3500
(719) 550-1010
(719) 550-1212
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DEN9841
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64479871
—
CO
Enumeration date
04/23/2015
Last updated
04/23/2015
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