Organization
FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COLLIS JOHNSON JR. DDS (DENTIST OWNER)
(303) 322-1177
Entity
Organization
Contact information
Practice address
1756 VINE ST, DENVER, CO 80206-1120
(303) 322-1177
(303) 322-1199
Mailing address
1756 VINE STREET, DENVER, CO 80206
(303) 322-1177
(303) 322-1199
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
104176
CO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
105493
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02014769
—
CO
05
—
17178061
—
CO
Enumeration date
07/18/2012
Last updated
07/18/2012
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