MEDICARE: COLORADO DENTAL PROFESSIONALS, LLC

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	:	1659265262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO DENTAL PROFESSIONALS, LLC

Provider Business Mailing Address
First Line	:	10450 CHAMBERS RD
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-8618
Country	:	US
Telephone Number	:	303-418-2450
Fax Number	:	303-418-2452

Provider Business Practice Location Address
First Line	:	10450 CHAMBERS RD
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-8618
Country	:	US
Telephone Number	:	303-418-2450
Fax Number	:	303-418-2452

Authorized Official
Title or Position	:	CREDENITILING COORDINATOR
Name	:	CEMYIRA MCDOUGAL
Credential	:
Telephone Number	:	217-764-8609

Provider Enumeration Date	:	06/06/2025
Last Update Date	:	06/06/2025

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