Organization
MONUMENT CHILD DENTAL & ORTHODONTIC SPECIALISTS PC
Active
Other names
Erickson Pediatric Dentistry & Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN RUSH (BUSINESS MANAGER)
(719) 282-6666
Entity
Organization
Contact information
Practice address
850 SKY VISTA POINT, COLORADO SPRINGS, CO 80921-1400
(719) 488-1101
(719) 488-1115
Mailing address
9334 GRAND CORDERA PKWY, COLORADO SPRINGS, CO 80924-7000
(719) 282-6666
(719) 203-5477
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
9665
CO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
9665
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
29102251
—
CO
05
—
86708350
—
CO
Enumeration date
04/25/2012
Last updated
06/30/2022
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