COLORADO DENTAL SPECIALIST PRACTICE, LLC (NPI# 1568017077) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568017077 |
| Entity Type | Organization |
| Organization Name | COLORADO DENTAL SPECIALIST PRACTICE, LLC |
| Practice Address |
3715 Bloomington St Unit 160 Colorado Springs CO 80922-3207 |
| Practice Telephone | 7195990665 |
| Mailing Telephone | 7195990665 |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2019-08-02 |
| 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 | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
Dental Providers | ||
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Other Name | Type Code |
|---|---|
| All Smiles Orthodontics | Doing Business As Name - Organization |
| Colorado Dental Specialists | Doing Business As Name - Organization |
| Colorado Endodontic 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 |
| 1831743459 | Colorado Dental Specialist Practice, LLC | Dentist | 8085 Fountain Mesa Rd, Fountain, CO 80817-1591 | 2019-07-31 |
| 1184278715 | Colorado Dental Specialist Practice, LLC | Dentist | 3095 S Parker Rd Ste 150, Aurora, CO 80014-2917 | 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 |
3715 BLOOMINGTON ST UNIT 160 |
| City | COLORADO SPRINGS |
| State | CO |
| Zip Code | 80922-3207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649694480 | Sakib Vahora | Dentist | 3715 Bloomington St Unit 160, Colorado Springs, CO 80922-3207 | 2014-02-14 |
| 1457972002 | Lydia R Mcconnell | Dental Hygienist | 3715 Bloomington St Unit 160, Colorado Springs, CO 80922-3207 | 2020-05-05 |
| 1003460726 | My Local Colorado Dental Practice, LLC | Dentist | 3715 Bloomington St Unit 160, Colorado Springs, CO 80922-3207 | 2019-07-31 |
| 1487126223 | My Local Colorado Dental Practice, LLC | Dentist | 3715 Bloomington St Unit 160, Colorado Springs, CO 80922-3207 | 2018-12-18 |
| 1902321706 | Jillian Louise Bryant | Dental Hygienist | 3715 Bloomington St Unit 160, Colorado Springs, CO 80922-3207 | 2017-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427662709 | Emergency Medical Specialists, PC | Emergency Medicine | Powers Fsed - Md, 2770 N. Powers Blvd, Colorado Springs, CO 80922 | 2020-09-03 |
| 1578177895 | Emergency Medical Specialists, PC | Emergency Medicine | Powers Fsed - App, 2770 N. Powers Blvd, Colorado Springs, CO 80922 | 2020-09-03 |
| 1528566965 | Caitlin Corbeit Kroetsch | Massage Therapist | 5349 Ferraro Drive, Colorado Springs, CO 80922 | 2018-01-31 |
| 1154861169 | Miriam Freire | Dental Hygienist | 3759 Swainson Dr., Colorado Springs, CO 80922 | 2017-02-24 |
| 1528507712 | Brandon Hutchinson | Social Worker | 6972 Hillock Fr, Colorado Springs, CO 80922 | 2017-02-21 |
| 1841648052 | Delene Suzuki Babauta | Dental Assistant | 7279 Withers Pl, Colorado Springs, CO 80922 | 2016-05-27 |
| 1225442601 | Betsy Titus | Physical Therapy Assistant | 6355 Silverado Trl, Colorado Springs, CO 80922 | 2014-06-13 |
| 1255754214 | Lynor Dicang Hardy | Military Health Care Provider | Cheyenne Mountain Air Station, Colorado Springs, CO 80922 | 2014-01-28 |
| 1861774184 | North Powers Modern Dentistry, LLP | Dentist | 5430 Tutt Boulevard, Colorado Springs, CO 80922 | 2011-09-13 |
| 1255589297 | Kendra D Robison | Internal Medicine | 6340 E Barnes Road, Colorado Springs Health Partners Internal Medicine, Colorado Springs, CO 80922 | 2008-09-03 |
| Find all providers in zip 80922 | ||||
| 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 |
|---|---|---|---|---|
| 1053727024 | Mccombs Periodontics LLC | Dentist | 13335 Voyager Pkwy, Suite 130, Colorado Springs, CO 80921-7657 | 2014-07-10 |
| 1306869508 | James E. Orban | Dentist | 12245 Howells Rd, Colorado Springs, CO 80908-3700 | 2006-07-26 |
| 1538152806 | Thomas James Lynch | Dentist | 1675 Briargate Blvd, Ste C, Colorado Springs, CO 80920-3452 | 2005-08-23 |
| 1699973636 | Marmar Modarressi | Dentist | 1050 S 8th St, Colorado Springs, CO 80906-1307 | 2007-07-10 |
| 1356554828 | James Robert Norris | Dentist | 1975 Research Pkwy, Ste 305, Colorado Springs, CO 80920-1025 | 2007-05-08 |
| 1558581298 | Karl Lackler | Dentist | 685 Citadel Dr E, Suite 200, Colorado Springs, CO 80909-5314 | 2007-04-26 |
| 1619196342 | Geoffrey Haradon | Dentist | 685 Citadel Dr E, Suite 200, Colorado Springs, CO 80909-5314 | 2007-04-24 |
| 1205052842 | Rocky Mountain Periodontal Specialists | Dentist | 685 Citadel Dr E, Suite 200, Colorado Springs, CO 80909-5314 | 2007-04-18 |
| 1407070642 | Brian Douglas Fitzpatrick | Dentist | 320 E Fontanero St, Colorado Springs, CO 80907-7529 | 2007-04-12 |
| 1790810299 | Dan I Degeare | Dentist | 1819 N Circle Dr, Suite 5, Colorado Springs, CO 80909-2430 | 2007-02-23 |
| Find all providers in COLORADO SPRINGS | ||||
| City | COLORADO SPRINGS |
| Zip Code | 80922 |
Please comment or provide details below to improve the information on COLORADO DENTAL SPECIALIST PRACTICE, LLC.
| 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.