NPIMap

Organization Active NPI

Premier Dental Care

  • General Practice Dentistry
  • Colorado Springs, CO
National Provider Identifier
1003961061
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
104471 Issued in CO
Legal business name
PREMIER DENTAL CARE
Practice address
685 Citadel Dr E
Suite 302
Colorado Springs, CO 80909-5314
Phone
(719) 596-1011
Fax
(719) 596-6748
NPI assigned
Jan 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacob Warner
Title
Credentialing Manager
Phone
(801) 691-1701

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 104471 CO Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 6035 CO
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 6716 CO

Addresses

Primary practice location

685 Citadel Dr E
Suite 302
Colorado Springs, CO 80909-5314

Mailing address

PO Box 970084
Orem, UT 84097-0084
Phone (801) 691-1701

National Provider Directory

National Provider Directory

Locations

685 Citadel Dr E
Ste 302
Colorado Springs, CO 80909
Phone (719) 426-3468

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625184000000",
    "number": "1003961061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970084",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840970084",
            "telephone_number": "801-691-1701",
            "fax_number": "801-335-6551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "685 CITADEL DR E",
            "address_2": "SUITE 302",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095314",
            "telephone_number": "719-596-1011",
            "fax_number": "719-596-6748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "801-691-1701"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "104471",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "6035",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "6716",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.