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NPI Code Detail

MEDICARE: COLORADO DENTAL PROFESSIONALS, LLC

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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1821443649
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLORADO DENTAL PROFESSIONALS, LLC
Provider Business Mailing Address
First Line : 25531 E SMOKY HILL RD
Second Line : UNIT E
City : AURORA
State : CO
Zip : 80016-1391
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 25531 E SMOKY HILL RD
Second Line : UNIT E
City : AURORA
State : CO
Zip : 80016-1391
Country : US
Telephone Number : 720-325-1489
Fax Number :
Authorized Official
Title or Position : CREDENTIALING TEAM LEAD
Name : KENDRA WALKER
Credential :
Telephone Number : 217-540-8312
Provider Enumeration Date : 04/29/2016
Last Update Date : 04/29/2016

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Directions to “COLORADO DENTAL PROFESSIONALS, LLC ” Practice Location

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