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NPI Code Detail

MEDICARE: COLORADO DENTAL PROVIDERS

MEDICARE: COLORADO DENTAL PROVIDERS
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
11223G0001XGeneral Practice Dentistry8054CO

General Provider Information

NPI Number : 1437234267
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLORADO DENTAL PROVIDERS
Provider Business Mailing Address
First Line : 4100 MCEWEN RD
Second Line : SUITE 110
City : DALLAS
State : TX
Zip : 75244-5113
Country : US
Telephone Number : 972-755-0800
Fax Number :
Provider Business Practice Location Address
First Line : 3773 CHERRY CREEK NORTH DR
Second Line : SUITE 120
City : DENVER
State : CO
Zip : 80209-3804
Country : US
Telephone Number : 303-355-8670
Fax Number :
Authorized Official
Title or Position : CIO
Name : JOHN EVERETT BALLARD
Credential :
Telephone Number : 972-755-0800
Provider Enumeration Date : 10/27/2006
Last Update Date : 08/22/2020

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Directions to “COLORADO DENTAL PROVIDERS ” Practice Location

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