Organization
COLORADO DENTAL PROFESSIONALS, LLC
Active
Other names
Smoky Hill Dental
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA PETERSEN (CREDENTIALING TEAM LEAD)
(217) 540-8972
Entity
Organization
Contact information
Practice address
18525 E SMOKY HILL RD, SUITE D, CENTENNIAL, CO 80015-3108
(303) 617-9090
(303) 617-9838
Mailing address
18525 E SMOKY HILL RD, SUITE D, CENTENNIAL, CO 80015-3108
(303) 617-9090
(303) 617-9838
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
CO7099
CO
1223G0001X
General Practice Dentistry
Primary
CO7282
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700878626
DANIEL B NORRIE
CO
01
—
1861494494
ROB C MULLINS
CO
Enumeration date
05/21/2007
Last updated
11/14/2018
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