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General NPI Number Information
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NPI Number | 1558806679
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Entity Type | Organization
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Legal Business Name | SOCO ENDO
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 11/22/2023
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Provider Practice Location Address
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Address Line | 1275 LAKE PLAZA DRIVE SUITE #200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906
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Country | US
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Telephone | 719-301-1119
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Fax | 719-301-1131
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Provider Business Mailing Address
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Address Line | 1275 LAKE PLAZA DRIVE SUITE #200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906
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Country | US
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Telephone | 719-301-1119
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Fax | 719-301-1131
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Authorized Official
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Title or Position | ENDODONTIST/OWNER
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Name | DR. TYLER J. BOSS
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Credential | DDS
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Telephone | 719-301-1131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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