Organization · Type 2 NPI

Colorado Dental Specialist Practice, LLC

Periodontics · Superior, CO

NPI number 1124672753 Active

Practice location

1691 Coalton Rd
Superior, CO 80027-4681

Specialties and licenses

Taxonomy	Code	License
Endodontics	1223E0200X	None listed
Periodontics Primary	1223P0300X	None listed
Orthodontics and Dentofacial Orthopedics Dentistry	1223X0400X	None listed

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.

2 other providers at this address

NPI record

NPI: 1124672753
Entity type: Organization (Type 2)
Issued: Jul 31, 2019
Last updated: Jul 31, 2019
Status: Active
Subpart: Yes of Colorado Dental Specialist Practice, LLC

Other names

Colorado Dental Specialists · doing business as
Colorado Endodontic Group · doing business as
Colorado Orthdontic Group · doing business as

Authorized official

Michelle Johnson
Credentialing Specialist
(509) 315-8338

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1124672753

Colorado Dental Specialist Practice, LLC's National Provider Identifier is 1124672753, issued on Jul 31, 2019. The primary taxonomy on file is Periodontics (1223P0300X), and the practice location is in Superior, CO. The record was last updated on Jul 31, 2019.