Healthcare Provider Details

I. General information

NPI: 1992686513
Provider Name (Legal Business Name): MICHAEL D WONNACOTT DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 REAGAN HTS
COLORADO SPRINGS CO
80921-2313
US

IV. Provider business mailing address

881 REAGAN HTS
COLORADO SPRINGS CO
80921-2313
US

V. Phone/Fax

Practice location:
  • Phone: 719-488-2222
  • Fax:
Mailing address:
  • Phone: 719-488-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DAVID WONNACOTT
Title or Position: PRESIDENT
Credential: DDS
Phone: 719-466-3300