Organization
COLORADO DENTAL SPECIALIST PRACTICE, LLC
Active
Parent organization
COLORADO DENTAL SPECIALIST PRACTICE, LLC
Other names
Colorado Dental Specialists, Colorado Endodontic Group, All Smiles Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLORADO DENTAL SPECIALIST PRACTICE, LLC
Authorized official
MICHELLE JOHNSON (CREDENTIALING SPECIALIST)
(509) 315-8338
Entity
Organization
Contact information
Practice address
3715 BLOOMINGTON ST UNIT 160, COLORADO SPRINGS, CO 80922-3207
(719) 599-0665
Mailing address
3715 BLOOMINGTON ST UNIT 160, COLORADO SPRINGS, CO 80922-3207
(719) 599-0665
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223P0300X
Periodontics
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
08/02/2019
Last updated
08/02/2019
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