MEDICARE: WOODLAND PARK PEDIATRIC DENTISTRY

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1528932357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAND PARK PEDIATRIC DENTISTRY

Provider Business Mailing Address
First Line	:	101 SUNDIAL DR # A-3
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-7769
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 SUNDIAL DR # A-3
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-7769
Country	:	US
Telephone Number	:	415-990-6229
Fax Number	:

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	ELIZABETH PAULSEN
Credential	:	DDS
Telephone Number	:	415-990-6229

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/03/2025

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