MEDICARE: DDS ORTHODONTICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1154135481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DDS ORTHODONTICS PLLC

Provider Business Mailing Address
First Line	:	11765 ASH DR
Second Line	:
City	:	THORNTON
State	:	CO
Zip	:	80233-5114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 MARKET ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1932
Country	:	US
Telephone Number	:	248-760-4262
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DESIREA SCOTT-MOORE
Credential	:	DDS
Telephone Number	:	248-760-4262

Provider Enumeration Date	:	02/06/2025
Last Update Date	:	04/28/2026

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