Organization
COLORADO DENTAL SPECIALIST PRACTICE, LLC
Active
Parent organization
COLORADO DENTAL SPECIALIST PRACTICE, LLC
Other names
Colorado Oral Surgery Group
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
1005 W 120TH AVE STE 800, WESTMINSTER, CO 80234-2747
(720) 263-5420
Mailing address
1005 W 120TH AVE STE 800, WESTMINSTER, CO 80234-2747
(720) 263-5420
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
07/31/2019
Last updated
07/31/2019
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