Healthcare Provider Details

I. General information

NPI: 1851377014
Provider Name (Legal Business Name): JOHN N ORDAHL SR. D.D.S.M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 AUSTIN BLUFFS PKWY SUIET 215
COLORADO SPRINGS CO
80918
US

IV. Provider business mailing address

3505 AUSTIN BLUFFS PKWY SUIET 215
COLORADO SPRINGS CO
80918
US

V. Phone/Fax

Practice location:
  • Phone: 719-596-3098
  • Fax: 719-596-3009
Mailing address:
  • Phone: 719-596-3098
  • Fax: 719-596-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5462
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: