Healthcare Provider Details

I. General information

NPI: 1609100437
Provider Name (Legal Business Name): ROCKY MOUNTAIN PEDIATRIC DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2009
Last Update Date: 06/11/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 MULBERRY WOOD DR., STE 150
COLORADO SPRINGS CO
80908
US

IV. Provider business mailing address

7505 MULBERRY WOOD DR., STE 150
COLORADO SPRINGS CO
80908
US

V. Phone/Fax

Practice location:
  • Phone: 719-638-7673
  • Fax: 719-424-4928
Mailing address:
  • Phone: 719-638-7673
  • Fax: 719-424-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9798
License Number StateCO

VIII. Authorized Official

Name: JANELLE LYNN TONN
Title or Position: OWNER
Credential: DDS
Phone: 719-638-7673