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General NPI Number Information
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NPI Number | 1902202435
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Entity Type | Organization
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Legal Business Name | RANGEWOOD DENTAL
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Dates
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Enumeration Date | 11/11/2014
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Last Update Date | 11/11/2014
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Provider Practice Location Address
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Address Line | 3755 BRIARGATE BLVD #200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-4195
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Country | US
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Telephone | 719-632-2952
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Fax | 719-599-9400
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Provider Business Mailing Address
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Address Line | 3755 BRIARGATE BLVD #200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-4195
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Country | US
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Telephone | 719-632-2952
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Fax | 719-599-9400
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY N HICKENLOOPER
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Credential | DDS
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Telephone | 719-632-2952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 105305
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License Number State | CO
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