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	1223G0001X	General Practice Dentistry	CO7099	CO
2	1223G0001X	General Practice Dentistry	CO7282	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700878626	OTHER	CO	DANIEL B NORRIE
2	1861494494	OTHER	CO	ROB C MULLINS

General Provider Information

NPI Number	:	1770791790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO DENTAL PROFESSIONALS, LLC

Provider Business Mailing Address
First Line	:	18525 E SMOKY HILL RD
Second Line	:	SUITE D
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-3108
Country	:	US
Telephone Number	:	303-617-9090
Fax Number	:	303-617-9838

Provider Business Practice Location Address
First Line	:	18525 E SMOKY HILL RD
Second Line	:	SUITE D
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-3108
Country	:	US
Telephone Number	:	303-617-9090
Fax Number	:	303-617-9838

Authorized Official
Title or Position	:	CREDENTIALING TEAM LEAD
Name	:	CASSANDRA PETERSEN
Credential	:
Telephone Number	:	217-540-8972

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	11/14/2018

Similar Medicare Providers

1861494494 — DR. ROB CASEY MULLINS DDS
Practice Location Address:

18525 E SMOKY HILL RD , SUITE D
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1700878626 — DR. DANIEL BRYCE NORRIE DDS
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Directions to “COLORADO DENTAL PROFESSIONALS, LLC ” Practice Location

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