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General NPI Number Information
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NPI Number | 1821432196
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Entity Type | Organization
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Legal Business Name | CASTLE ROCK KIDS' DENTISTRY
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 2352 MEADOWS BLVD SUITE 200
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City | CASTLE ROCK
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State | CO
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Zip | 80109
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Country | US
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Telephone | 719-598-6254
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Fax |
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Provider Business Mailing Address
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Address Line | 30 LONE PINE WAY
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-2544
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Country | US
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Telephone | 719-598-6254
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Fax |
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. MICHAEL KEYES TOWNSEND
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Credential | DDS
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Telephone | 850-830-4861
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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 | 8564
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License Number State | CO
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