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General NPI Number Information
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NPI Number | 1992063176
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Entity Type | Organization
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Legal Business Name | MONUMENT CHILD DENTAL & ORTHODONTIC SPECIALISTS PC
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 850 SKY VISTA POINT
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-1400
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Country | US
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Telephone | 719-488-1101
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Fax | 719-488-1115
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Provider Business Mailing Address
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Address Line | 9334 GRAND CORDERA PKWY
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City | COLORADO SPRINGS
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State | CO
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Zip | 80924-7000
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Country | US
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Telephone | 719-282-6666
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Fax | 719-203-5477
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | DAWN RUSH
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Credential |
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Telephone | 719-282-6666
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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 | 9665
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 9665
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License Number State | CO
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