MEDICARE: COLUMBINE FAMILY DENTAL, 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	122300000X	Dentist

General Provider Information

NPI Number	:	1447920731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBINE FAMILY DENTAL, PLLC

Provider Business Mailing Address
First Line	:	15660 DALLAS PKWY STE 950
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-3309
Country	:	US
Telephone Number	:	214-702-0729
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 S PIERCE ST STE 335
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80128-7202
Country	:	US
Telephone Number	:	303-973-1900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW HALE
Credential	:
Telephone Number	:	214-702-0729

Provider Enumeration Date	:	09/17/2021
Last Update Date	:	01/28/2026

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