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General NPI Number Information
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NPI Number | 1801027925
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Entity Type | Organization
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Legal Business Name | JOHN N. ORDAHL DDS MS
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 3505 AUSTIN BLUFFS PKWY STE 215
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-5754
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Country | US
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Telephone | 719-596-3098
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Fax | 719-596-3099
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Provider Business Mailing Address
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Address Line | 3505 AUSTIN BLUFFS PKWY STE 215
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-5754
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Country | US
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Telephone | 719-596-3098
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Fax | 719-596-3099
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN ORDAHL
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Credential | DDS, MS
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Telephone | 719-596-3098
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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 | 5462
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License Number State | CO
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