Healthcare Provider Details

I. General information

NPI: 1508023805
Provider Name (Legal Business Name): ALL KIDS DENTAL PEDIATRICS AND ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 01/11/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 AIRPORT RD
RIFLE CO
81650-8527
US

IV. Provider business mailing address

2624 GRAND AVE STE 200
GLENWOOD SPRINGS CO
81601-4676
US

V. Phone/Fax

Practice location:
  • Phone: 970-625-9500
  • Fax: 970-928-7467
Mailing address:
  • Phone: 970-928-9500
  • Fax: 970-928-7467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CASEY W JOHNSON
Title or Position: PARTNER
Credential: DDS
Phone: 970-928-9500