Organization
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Active
Parent organization
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Other names
Exceptional Smiles
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
10807 NEW ALLEGIANCE DR STE 465, COLORADO SPRINGS, CO 80921-3722
(719) 548-9393
Mailing address
10807 NEW ALLEGIANCE DR STE 465, COLORADO SPRINGS, CO 80921-3722
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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