Healthcare Provider Details

I. General information

NPI: 1114851979
Provider Name (Legal Business Name): SB WEST DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4185 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-3767
US

IV. Provider business mailing address

4185 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-3767
US

V. Phone/Fax

Practice location:
  • Phone: 719-424-4668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA FREYRE
Title or Position: INSURANCE/BILLING MANAGER
Credential:
Phone: 719-424-4668