Organization
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Active
Parent organization
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Other names
Modern Dental At Flying Horse
Organization subpart
Yes
Provider details
NPI number
Legal business name
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Authorized official
GREGORY KOSTELAC (DATA ANALYST)
(719) 372-5605
Entity
Organization
Contact information
Practice address
2730 N GATE BLVD, COLORADO SPRINGS, CO 80921-3419
(719) 394-8048
Mailing address
6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/04/2022
Last updated
04/04/2022
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