COLORADO DENTAL SPECIALIST PRACTICE, LLC (NPI# 1184278715) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184278715 |
| Entity Type | Organization |
| Organization Name | COLORADO DENTAL SPECIALIST PRACTICE, LLC |
| Practice Address |
3095 S Parker Rd Ste 150 Aurora CO 80014-2917 |
| Practice Telephone | 3037558388 |
| Mailing Telephone | 3037558388 |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2019-07-31 |
| Authorized Official Name | MICHELLE JOHNSON (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 5093158338 |
| Is Organization Subpart | Y |
| Parent Organization Name | COLORADO DENTAL SPECIALIST PRACTICE, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223E0200X |
Dentist Specialization: Endodontics |
Dental Providers | ||
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers | ||
| N | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
Dental Providers | ||
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Colorado Dental Specialists | Doing Business As Name - Organization |
| Colorado Endodontic Group | Doing Business As Name - Organization |
| Colorado Oral Surgery Group | Doing Business As Name - Organization |
| Colorado Orthodontic Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518511146 | Colorado Dental Specialist Practice, LLC | Dentist | 18121 E Hampden Ave Unit E, Aurora, CO 80013-3591 | 2019-07-31 |
| 1649825886 | Colorado Dental Specialist Practice, LLC | Dentist | 6110 Barnes Rd, Colorado Springs, CO 80922-2600 | 2019-08-05 |
| 1568017077 | Colorado Dental Specialist Practice, LLC | Dentist | 3715 Bloomington St Unit 160, Colorado Springs, CO 80922-3207 | 2019-08-02 |
| 1831743459 | Colorado Dental Specialist Practice, LLC | Dentist | 8085 Fountain Mesa Rd, Fountain, CO 80817-1591 | 2019-07-31 |
| 1780238311 | Colorado Dental Specialist Practice, LLC | Dentist | 1160 W Ash St, Windsor, CO 80550-4666 | 2019-07-31 |
| 1740834381 | Colorado Dental Specialist Practice, LLC | Dentist | 1005 W 120th Ave Ste 800, Westminster, CO 80234-2747 | 2019-07-31 |
| 1407400039 | Colorado Dental Specialist Practice, LLC | Dentist | 2800 E 136th Ave, Thornton, CO 80241-3417 | 2019-07-31 |
| 1841844479 | Colorado Dental Specialist Practice, LLC | Dentist | 3955 E 120th Ave Ste B, Thornton, CO 80233-2075 | 2019-07-31 |
| 1497309058 | Colorado Dental Specialist Practice, LLC | Dentist | 3236 Centennial Blvd, Colorado Springs, CO 80907-4077 | 2019-07-31 |
| 1326692955 | Colorado Dental Specialist Practice, LLC | Dentist | 3550 W 38th Ave Ste 50, Denver, CO 80211-2000 | 2019-07-31 |
| Street Address |
3095 S PARKER RD STE 150 |
| City | AURORA |
| State | CO |
| Zip Code | 80014-2917 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720462096 | Crystal Kim | Dentist | 3095 S Parker Rd Ste 150, Aurora, CO 80014-2917 | 2015-07-16 |
| 1487208146 | My Local Colorado Dental Practice, LLC | Dentist | 3095 S Parker Rd Ste 150, Aurora, CO 80014-2917 | 2019-07-30 |
| 1851776058 | Panorama Dental Professional LLC | Dentist | 3095 S Parker Rd Ste 150, Aurora, CO 80014-2917 | 2015-07-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942825021 | Dieuvil Varice | Occupational Therapist | 2851 S Parker Rd Ste 570, Aurora, Co, Aurora, CO 80014 | 2020-06-14 |
| 1518437144 | Curtis E Redd | Case Manager/Care Coordinator | 1059 E Bethany Dr, Suite 200, Aurora, CO 80014 | 2018-11-27 |
| 1144795154 | Prestige Adult Day Care LLC | Clinic/Center | 2860 S Havana St, Unit C, Aurora, CO 80014 | 2018-10-05 |
| 1609375492 | Jacob Mcbride | Behavior Technician | 2121 S Blackhawk St 100, Aurora, CO 80014 | 2018-02-07 |
| 1265931240 | Jasmine Nicole Joseph | Behavior Technician | 2121 S. Blackhawk St., Aurora, CO 80014 | 2018-02-06 |
| 1255830238 | Russel Talukder | Behavioral Analyst | 2121 South Blackhawk St 100, Aurora, CO 80014 | 2018-02-06 |
| 1467951442 | Dylan Kelley | Behavior Technician | 2121 Blackhawk St. Suite 100, Aurora, CO 80014 | 2018-02-06 |
| 1184123168 | Talisa Fisher | Behavior Technician | 2121 S Blackhawk St Suite 100, Aurora, CO 80014 | 2018-02-06 |
| 1144732314 | Hellen A Noamesi | Registered Nurse | Kaiser Water Park 1, 2500 S. Havana St, Aurora, CO 80014 | 2017-10-27 |
| 1255840641 | Amanda Dawn Thompson | Massage Therapist | 3035 South Parker Rd., 560 Building E, Aurora, CO 80014 | 2017-09-28 |
| Find all providers in zip 80014 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457656159 | Randolph Scott Ziegler | Dentist | 13065 E 17th Ave Ste F847, Room 130, Aurora, CO 80045-2534 | 2011-01-11 |
| 1891927307 | Jonathan Charles Boynton | Dentist | 13065 E 17th Ave Rm 111, Aurora, CO 80045-2532 | 2009-08-17 |
| 1477604478 | Robert John Denny | Dentist | 14001 E. Iliff Ave., Ste. 104, Aurora, CO 80014-1424 | 2007-01-16 |
| 1962580340 | Robert M Pick | Dentist | 95 Trade St, #104, Aurora, IL 60504 | 2006-11-01 |
| 1255305116 | Charles Anthony Powell | Dentist | 13065 E 17th Ave Rm 130k, Mail Stop F847, Aurora, CO 80045-2532 | 2006-02-15 |
| 1508837410 | Lonnie Johnson | Dentist | 1635 Ursula St, Aurora, CO 80010-7402 | 2006-01-30 |
| 1316396518 | Grand Dental Associates, P.C. | Dentist | 1780 N Farnsworth Ave, Aurora, IL 60505-1576 | 2016-06-08 |
| 1689029761 | Lauren Metzger | Dentist | 13065 E 17th Ave, Mail Stop F-850, Room 111, Aurora, CO 80045-2532 | 2016-04-26 |
| 1982006763 | Chacon Dental Group | Dentist | 3535 E New York St, Aurora, IL 60504-4465 | 2014-09-23 |
| 1528303484 | Elite Periodontics PC | Dentist | 2124 Ogden Ave, Suite 104, Aurora, IL 60504-7514 | 2012-12-04 |
| Find all providers in AURORA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.