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NPI Code Detail

MEDICARE: DENTAL HEALTH PROFESSIONALS OF COLORADO

MEDICARE: DENTAL HEALTH PROFESSIONALS OF COLORADO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1710477732
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENTAL HEALTH PROFESSIONALS OF COLORADO
Provider Business Mailing Address
First Line : 830 TENDERFOOT HILL RD STE 210
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-7372
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 830 TENDERFOOT HILL RD STE 210
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-7372
Country : US
Telephone Number : 719-576-8840
Fax Number :
Authorized Official
Title or Position : CREDENTIALING TEAM LEAD
Name : CASSANDRA PETERSEN
Credential :
Telephone Number : 217-540-8972
Provider Enumeration Date : 05/15/2018
Last Update Date : 05/15/2018

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Directions to “DENTAL HEALTH PROFESSIONALS OF COLORADO ” Practice Location

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