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General NPI Number Information
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NPI Number | 1851377014
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Entity Type | Individual
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Provider Name | JOHN N ORDAHL SR. D.D.S.M.S.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 3505 AUSTIN BLUFFS PKWY SUIET 215
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918
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Country | US
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Telephone | 719-596-3098
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Fax | 719-596-3009
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Provider Business Mailing Address
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Address Line | 3505 AUSTIN BLUFFS PKWY SUIET 215
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918
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Country | US
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Telephone | 719-596-3098
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Fax | 719-596-3009
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5462
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License Number State | CO
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