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General NPI Number Information
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NPI Number | 1720171564
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Entity Type | Organization
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Legal Business Name | COLORADO DENTAL PROFESSIONALS, LLC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 11/16/2018
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Provider Practice Location Address
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Address Line | 6980 MESA RIDGE PARKWAY SUITE 200
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City | FOUNTAIN
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State | CO
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Zip | 80817
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Country | US
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Telephone | 719-392-4231
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Fax | 719-392-9096
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Provider Business Mailing Address
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Address Line | 6980 MESA RIDGE PARKWAY SUITE 200
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City | FOUNTAIN
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State | CO
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Zip | 80817
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Country | US
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Telephone | 719-392-4231
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Fax | 719-392-9096
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Authorized Official
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Title or Position | CRED COORDINATOR
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Name | BRITTANY N HOWARD
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Credential |
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Telephone | 217-540-8946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 270
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License Number State | CO
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