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General NPI Number Information
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NPI Number | 1508023805
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Entity Type | Organization
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Legal Business Name | ALL KIDS DENTAL PEDIATRICS AND ORTHODONTICS
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 990 AIRPORT RD
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City | RIFLE
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State | CO
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Zip | 81650-8527
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Country | US
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Telephone | 970-625-9500
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Fax | 970-928-7467
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Provider Business Mailing Address
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Address Line | 2624 GRAND AVE STE 200
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4676
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Country | US
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Telephone | 970-928-9500
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Fax | 970-928-7467
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Authorized Official
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Title or Position | PARTNER
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Name | CASEY W JOHNSON
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Credential | DDS
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Telephone | 970-928-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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