Organization
ACADEMY KIDS DENTAL CENTER PC
Active
Other names
Academy Kids Dental, Vision and Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN URBANOZO (CREDENTIALING MANAGER)
(719) 323-2362
Entity
Organization
Contact information
Practice address
2436 S ACADEMY BLVD, COLORADO SPRINGS, CO 80916-2408
(719) 391-2336
(719) 391-1625
Mailing address
2221 E BIJOU ST STE 100, COLORADO SPRINGS, CO 80909-8009
(719) 955-8896
(719) 955-3470
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
7992
CO
1223G0001X
General Practice Dentistry
Primary
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1630472
UNITED CONCORDIA ID
CO
05
—
66286026
—
CO
Enumeration date
07/02/2006
Last updated
11/18/2020
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