Organization
MOUNTAIN SHADOWS FAMILY DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL E HOLSTEEN D.D.S. (PRESIDENT)
(719) 598-3502
Entity
Organization
Contact information
Practice address
1045 GARDEN OF THE GODS ROAD, SUITE N, COLORADO SPRINGS, CO 80907-3436
(719) 598-3502
(719) 598-9264
Mailing address
1045 GARDEN OF THE GODS ROAD, SUITE N, COLORADO SPRINGS, CO 80907-3436
(719) 598-3502
(719) 598-9264
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
105376
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912991779
NPI TYPE 1
CO
Enumeration date
03/29/2007
Last updated
08/22/2020
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