Organization
HERO DENTAL OF SPRINGS PC
Active
Other names
Academy Kids Dental and Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN URBANOZO (CREDENTIALING MANAGER)
(719) 323-2362
Entity
Organization
Contact information
Practice address
3630 AUSTIN BLUFFS PKWY STE 100-120, COLORADO SPRINGS, CO 80918-6661
(719) 304-5400
(719) 304-5409
Mailing address
2221 E BIJOU ST STE 100, COLORADO SPRINGS, CO 80909-8009
(719) 576-1850
(719) 955-3470
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
CO
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52001873
—
CO
Enumeration date
09/17/2009
Last updated
11/18/2020
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