Organization
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Active
Parent organization
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Other names
Sage Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Authorized official
MICHELLE JOHNSON (CREDENTIALING SPECIALIST)
(509) 315-8338
Entity
Organization
Contact information
Practice address
2695 NORTHPARK DR STE 104, LAFAYETTE, CO 80026-3177
(720) 477-4908
Mailing address
2695 NORTHPARK DR STE 104, LAFAYETTE, CO 80026-3177
(720) 477-4908
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/30/2019
Last updated
07/30/2019
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