MEDICAID DENTAL HOME


Address: 2125 E La Salle St, Colorado Springs, CO 80909-2274
Phone: 7193103315

MEDICAID DENTAL HOME (NPI# 1336570167) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1336570167
Entity Type Organization
Organization Name MEDICAID DENTAL HOME
Practice Address 2125 E La Salle St
Colorado Springs
CO 80909-2274
Mailing Address 2604 Flintridge Dr
Colorado Springs
CO 80918-4408
Practice Telephone 7193103315
Mailing Telephone 7193382195
Enumeration Date 2013-12-04
Last Update Date 2013-12-04
Authorized Official Name MICHELLE VACHA (EXECUTIVE DIRECTOR)
Authorized Official Telephone 7193382195
Authorized Official Credential RDH
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 124Q00000X Dental Hygienist 903783 CO Dental Providers
Y 1223D0001X Dentist
Specialization: Dental Public Health
8109 CO Dental Providers

Other Provider Identifier

State Issuer Identifier Type Code
CO 84887761 05

Office Location

Street Address 2125 E LA SALLE ST
City COLORADO SPRINGS
State CO
Zip Code 80909-2274

Providers in the same location

NPI Name Taxonomy Address Enumeration
1730126558 Christian Healing Network Clinic/Center 2125 E La Salle St, Colorado Springs, CO 80909-2274 2006-06-01
1740623842 W A Munson Md LLC Internal Medicine 2125 E La Salle St, Suite M13, Colorado Springs, CO 80909-2274 2013-04-09
1609038330 Mary Vanoyen Force Registered Nurse 2125 E La Salle St, Colorado Springs, CO 80909-2274 2008-06-25

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1376173765 Ascent Health LLC Community/Behavioral Health 2608 Palmer Park Blvd., Colorado Springs, CO- COLORADO 80909 2020-01-24
1639714041 Peak Vista Community Health Centers Clinic/Center 4041 E San Miguel St, Colorado Springs, CO 80909 2019-11-08
1437706231 Cvs Pharmacy Inc Durable Medical Equipment & Medical Supplies 445 N Circle Drive, Colorado Springs, CO 80909 2019-08-26
1760952964 James Garofalo Counselor 2210 E La Salle St Ste 221, Colorado Spgs, CO 80909 2018-11-29
1144719055 Autumn Leaves Counseling, LLC Counselor 2130 Academy Circle, Suite B, Co Springs, CO 80909 2018-05-07
1407353642 Ambulnz Co, LLC Ambulance 2420 E Pikes Peak Ave Ste 1001, Colorado Springs, CO 80909 2018-04-12
1083117998 Peak Wellness Counseling Service, LLC Counselor 2210 E. La Salle Street, Suite 208, Colorado Springs, CO 80909 2018-03-16
1043740822 Ande Carol West Dental Hygienist 701 Citadel Drive East, Colorado Springs, CO 80909 2017-06-14
1043748791 Colorado Springs Pharmacy LLC Pharmacy 2224 E. Pikes Peak Ave, Colorado Springs, CO 80909 2017-05-25
1215484365 Brittney Nicole Roberts Physical Therapist 2201 Lelaray St., Colorado Springs, CO 80909 2016-09-07
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Taxonomy Information

Taxonomy Code 1223D0001X
Grouping Dental Providers
Classification Dentist
Specialization Dental Public Health

Taxonomy Definition

The science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice that serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis.
Notes: Source: Council on Dental Education and Licensure, American Dental Association

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1407855117 Melissa Ann Musolf Dentist 6140 Tutt Blvd, Suite 150, Colorado Springs, CO 80922-3575 2005-07-15
1790137131 Taylor Kennedy Dentist 2828 International Cir, Suite 100, Colorado Springs, CO 80910-3127 2016-07-11
1427058445 Edward J Mcculloch Dentist 3585 Van Teylingen Dr, Ste F, Colorado Springs, CO 80917-4875 2005-08-01

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1891281747 Community Health Services, Inc. Dentist 0405 Castle Creek Rd., Suite 6, Aspen, CO 81611 2018-07-03
1215113402 Total Oral Prevention Strategies Dentist 3216 High St, Denver, CO 80205-4062 2008-01-17
1386828929 Hanh H Phi Dentist 199 Quebec St Unit B, Denver, CO 80220-6186 2007-12-18
1932175346 Community Dental Clinic, Inc. Dentist 87 Merchant Dr, Montrose, CO 81401-3015 2006-02-24
1558360073 Casey Lee Kochevar Dentist 1446 Hover Street, Suite #100, Longmont, CO 80501 2005-07-18
1548269269 James B. Moses Dentist 6000 E Evans Ave, Bld 3 Suite 200, Denver, CO 80222-5406 2005-07-14
1326046137 Kenneth S Lahr Dentist 19423 N Turkey Creek Rd, Morrison, CO 80465-8902 2005-07-14
1659378701 Dennis James Lewis Dentist 877 South Boulder Road, Louisville, CO 80027-1345 2005-07-05
1265067425 Mobile Outreach Alliance Dentist 8422 W 78th Cir, Arvada, CO 80005-4407 2020-03-09
1508428434 Margaret Chavez Dentist 421 Walnut Street, La Jara, CO 81140 2019-07-01
Find all providers with the same taxonomy

Competitor

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City COLORADO SPRINGS
Zip Code 80909

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Dataset Information

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.

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