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General NPI Number Information
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NPI Number | 1811473861
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Entity Type | Organization
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Legal Business Name | VSB COLORADO PROVIDERS PLLC
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 1750 TELSTAR DRIVE, SUITE 200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920
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Country | US
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Telephone | 818-306-3215
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Fax |
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Provider Business Mailing Address
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Address Line | 1942 CAMINITO DE LA ESTRELLA
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City | GLENDALE
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State | CA
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Zip | 91208-3000
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Country | US
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Telephone | 818-306-3215
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT AND OFFICER
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Name | MICHAEL DRIESSEN
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Credential |
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Telephone | 818-306-3215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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