Organization
DENTAL HEALTH PROFESSIONALS OF COLORADO
Active
Parent organization
DENTAL HEALTH PROFESSIONALS OF COLORADO
Other names
Lake Avenue Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL HEALTH PROFESSIONALS OF COLORADO
Authorized official
CASSANDRA PETERSEN (CREDENTIALING TEAM LEAD)
(217) 540-8972
Entity
Organization
Contact information
Practice address
830 TENDERFOOT HILL RD STE 210, COLORADO SPRINGS, CO 80906-7372
(719) 576-8840
Mailing address
830 TENDERFOOT HILL RD STE 210, COLORADO SPRINGS, CO 80906-7372
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/15/2018
Last updated
05/15/2018
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