Organization
COLORADO DENTAL SPECIALIST PRACTICE, LLC
Active
Other names
Colorado Oral Surgery Group, Colorado Endodontic Group, Discovery Kids Pediatric Dentistry, All Smiles Orthodontics, Colorado Dental Specialists, Colorado Orthodontic Group
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JOHNSON (CREDENTIALING SPECIALIST)
(509) 315-8338
Entity
Organization
Contact information
Practice address
6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
(719) 427-6390
Mailing address
6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
(719) 266-2717
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201948
STATE OF COLORADO
CO
Enumeration date
05/10/2013
Last updated
07/31/2019
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