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General NPI Number Information
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NPI Number | 1609224195
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Entity Type | Organization
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Legal Business Name | SPRINGS PEDIATRIC DENTAL CARE
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 13335 VOYAGER PARKWAY 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-7657
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Country | US
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Telephone | 719-265-9600
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Fax | 719-265-9899
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Provider Business Mailing Address
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Address Line | 13335 VOYAGER PARKWAY 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-7657
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Country | US
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Telephone | 719-265-9600
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Fax | 719-265-9899
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. CLINTON THOMAS CALLAHAN
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Credential | DMD
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Telephone | 719-265-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8468
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License Number State | CO
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