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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CO | 84887761 | 05 |
Street Address |
2125 E LA SALLE ST |
City | COLORADO SPRINGS |
State | CO |
Zip Code | 80909-2274 |
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 |
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 |
Find all providers in zip 80909 |
Taxonomy Code | 1223D0001X |
Grouping | Dental Providers |
Classification | Dentist |
Specialization | Dental Public Health |
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 |
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 |
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 |
City | COLORADO SPRINGS |
Zip Code | 80909 |
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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.