Healthcare Provider Details

I. General information

NPI: 1366371296
Provider Name (Legal Business Name): CO ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16756 E SMOKY HILL RD
CENTENNIAL CO
80015-2470
US

IV. Provider business mailing address

108 MOUNTAIN VW
BOERNE TX
78006-6228
US

V. Phone/Fax

Practice location:
  • Phone: 303-248-7200
  • Fax:
Mailing address:
  • Phone: 210-902-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES ROBERT VANDEBERG
Title or Position: MANAGER
Credential: DDS, MS
Phone: 210-902-9122