Organization · Type 2 NPI

My Local Colorado Dental Practice, LLC

General Practice Dentistry · Pueblo, CO

NPI number 1821642596 Active

Practice location

1800 Fortino Blvd
Pueblo, CO 81008-1890

Specialties and licenses

Taxonomy	Code	License
General Practice Dentistry Primary	1223G0001X	None listed

General Practice Dentistry: A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

4 other providers at this address

Other general practice dentistry providers in Pueblo

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NPI record

NPI: 1821642596
Entity type: Organization (Type 2)
Issued: Jul 30, 2019
Last updated: Jul 30, 2019
Status: Active
Subpart: Yes of My Local Colorado Dental Practice, LLC

Other names

Advantage Dental 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 1821642596

My Local Colorado Dental Practice, LLC's National Provider Identifier is 1821642596, issued on Jul 30, 2019. The primary taxonomy on file is General Practice Dentistry (1223G0001X), and the practice location is in Pueblo, CO. The record was last updated on Jul 30, 2019.