Organization
MY LOCAL TEXAS DENTAL PRACTICE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG KOSTELAC (CREDENTIALING SPECIALIST)
(719) 372-5605
Entity
Organization
Contact information
Practice address
6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
(719) 266-2717
Mailing address
6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
(719) 266-2717
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/06/2021
Last updated
06/06/2021
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