Organization
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Active
Parent organization
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Other names
South Springs Dental Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Authorized official
MICHELLE JOHNSON (CREDENTIALING SPECIALIST)
(509) 315-8338
Entity
Organization
Contact information
Practice address
6514 S ACADEMY BLVD, COLORADO SPRINGS, CO 80906-8614
(719) 494-0718
Mailing address
6514 S ACADEMY BLVD, COLORADO SPRINGS, CO 80906-8614
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/30/2019
Last updated
07/30/2019
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