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General NPI Number Information
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NPI Number | 1619718327
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Entity Type | Organization
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Legal Business Name | RIDGELINE FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 11550 RIDGELINE DR UNIT 112
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-3953
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Country | US
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Telephone | 719-344-8616
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Fax |
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Provider Business Mailing Address
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Address Line | 6240 WOODMEN PARK VW
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-2616
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Country | US
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Telephone | 785-236-1408
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN L TUTTLE
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Credential | DDS
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Telephone | 785-236-1408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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