Organization
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JOHNSON (CREDENTIALING SPECIALIST)
(509) 315-8338
Entity
Organization
Contact information
Practice address
2721 W 120TH AVE STE 200, WESTMINSTER, CO 80234-2946
(303) 586-6985
(719) 213-2311
Mailing address
6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/05/2018
Last updated
12/05/2018
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