Colorado Dental Professionals, LLC
Organization Active NPI General Practice Dentistry · Loveland, CO
NPI 1013697150 · NPPES record last updated Jul 24, 2023
Key facts
- NPI
- 1013697150
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Legal business name
- COLORADO DENTAL PROFESSIONALS, LLC
- Practice address
- 2975 Ginnala Dr Ste 100
Loveland, CO 80538-3300 - Phone
- (970) 443-7117
- NPI assigned
- Jul 24, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- HEARTLAND DENTAL
Authorized official
- Name
- Hillary Thull
- Title
- Credentialing Coordinator
- Phone
- (217) 540-8946
Corporate family (same tax ID) 43
Practitioners 4
-
Ryan S Olson, DDS
-
Nicole Marie Ferrara, D.D.S.
-
Theodore E. Mioduski III, D.D.S.
-
Theodore Eugene Mioduski Jr., D.D.S.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231220002625 | CO | DME Supplier - Oral Surgery - Dentist | 6709236573 | Practice locations: Loveland, CO |
National Provider Directory
- Tax ID family
- Colorado Dental Professionals LLC
- Part of
- Colorado Dental Professionals LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | Yes |
Addresses
Primary practice location
2975 Ginnala Dr Ste 100
Loveland, CO 80538-3300
Mailing address
2975 Ginnala Dr Ste 100
Loveland, CO 80538-3300
Other names
- Implant & General Dentistry of Northern Colorado
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- Colorado Foundation for Conductive Education
- Colorado Foundation for Conductive Education
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All providers in Loveland, CO · General Practice Dentistry in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.