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NPI Code Detail

MEDICARE: CO SPECIALTY DENTAL SERVICES, PLLC

MEDICARE: CO SPECIALTY DENTAL SERVICES, PLLC
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number : 1770349920
Entity Type Code : Organization
Provider Name (Legal Business Name) : CO SPECIALTY DENTAL SERVICES, PLLC
Provider Business Mailing Address
First Line : 1610 54TH AVE N STE 205
Second Line :
City : NASHVILLE
State : TN
Zip : 37209-1442
Country : US
Telephone Number : 615-678-0759
Fax Number :
Provider Business Practice Location Address
First Line : 905 W 124TH AVE STE 180
Second Line :
City : WESTMINSTER
State : CO
Zip : 80234-1716
Country : US
Telephone Number : 303-255-3339
Fax Number :
Authorized Official
Title or Position : DIREC OF CRED &PR
Name : CHARLOTTE DASCH
Credential :
Telephone Number : 303-255-3339
Provider Enumeration Date : 02/26/2024
Last Update Date : 02/26/2024

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Directions to “CO SPECIALTY DENTAL SERVICES, PLLC ” Practice Location

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