Healthcare Provider Details

I. General information

NPI: 1942673397
Provider Name (Legal Business Name): COLORADO SPRINGS DENTAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E FOUNTAIN BLVD UNIT 100
COLORADO SPRINGS CO
80903-4160
US

IV. Provider business mailing address

251 E FOUNTAIN BLVD UNIT 100
COLORADO SPRINGS CO
80903-4160
US

V. Phone/Fax

Practice location:
  • Phone: 719-591-2004
  • Fax:
Mailing address:
  • Phone: 719-591-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7348
License Number StateCO

VIII. Authorized Official

Name: ARNOLD CULLUM
Title or Position: PRESIDENT
Credential: DDS
Phone: 719-591-2004