Organization
WOODMOOR FAMILY DENTISTRY
Active
Other names
Woodmoor Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW WILSON DETHLOFF DDS (OWNER/DENTIST)
(719) 488-3014
Entity
Organization
Contact information
Practice address
1777 LAKE WOODMOOR DR, MONUMENT, CO 80132-9074
(719) 488-3014
(719) 488-3015
Mailing address
1777 LAKE WOODMOOR DR, MONUMENT, CO 80132-9074
(719) 488-3014
(719) 488-3015
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000181282
—
CO
Enumeration date
02/18/2021
Last updated
02/18/2021
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