Organization
COLORADO DENTAL SPECIALIST PRACTICE, LLC
Active
Parent organization
COLORADO DENTAL SPECIALIST PRACTICE, LLC
Other names
Colorado Dental Specialists, All Smiles Orthodontics, Colorado Endodontic Group, Colorado Oral Surgery Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLORADO DENTAL SPECIALIST PRACTICE, LLC
Authorized official
MICHELLE JOHNSON (CREDENTIALING SPECIALISTS)
(509) 315-8338
Entity
Organization
Contact information
Practice address
6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
(719) 630-3366
Mailing address
6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
(719) 630-3366
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
08/05/2019
Last updated
09/12/2019
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