Healthcare Provider Details

I. General information

NPI: 1396348884
Provider Name (Legal Business Name): COLORADO SPRINGS PEDIATRIC DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 SOUTHPOINTE CT STE 100
COLORADO SPRINGS CO
80906-3806
US

IV. Provider business mailing address

9480 BRIAR VILLAGE PT STE 301
COLORADO SPRINGS CO
80920-7923
US

V. Phone/Fax

Practice location:
  • Phone: 719-522-0123
  • Fax: 719-375-8556
Mailing address:
  • Phone: 719-522-0123
  • Fax: 719-266-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CASSIE MICHELLE SEARS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 719-522-0123