MEDICARE: MOUNTAIN VIEW DENTAL CARE 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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1770390494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VIEW DENTAL CARE PLLC

Provider Business Mailing Address
First Line	:	15660 DALLAS PKWY STE 925
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-3323
Country	:	US
Telephone Number	:	214-702-0740
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 INVERNESS DR E STE 310
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-5139
Country	:	US
Telephone Number	:	303-768-8977
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	AMANDA LIGHTFOOT
Credential	:
Telephone Number	:	214-702-0708

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	01/06/2026

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