Prestige Dental Pueblo, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PRESTIGE DENTAL PUEBLO, PLLC

Doing business as

Prestige Dental Center South (Pueblo)

Practice address

1700 N Salem Ave Ste B
Pueblo, CO 81001-2861

Phone

(719) 582-4222

NPI assigned

Jan 13, 2025

Organization subpart

No

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

Authorized official

Name

Nick Sundiam

Title

Credentialing Manager

Phone

(719) 300-5933

Specialties & licenses 1

Addresses

Other names 1

• Prestige Dental Center South (Pueblo) Doing business as

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

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1083424758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 N SALEM AVE STE B",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810012861",
            "telephone_number": "719-582-4222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N SALEM AVE STE B",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810012861",
            "telephone_number": "719-582-4222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE DENTAL PUEBLO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "SUNDIAM",
        "authorized_official_first_name": "NICK",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "719-300-5933"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prestige Dental Center South (Pueblo)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Premier Home Health, Inc (Abode Home Health of Colorado)
• Premium Direct Care Providers Inc.
• Prescription Shop LLC
• Prescription Shop LLC (Jim Sajbel's Prescription Shop)
• Blair Christian Presti, MD
• Prestige Denture Clinic
• Prestige Peak Medical
• Stephen Peter Prewitt, PTA
• Beverly Price
• Sara A Price, H.A.D

• General Practice Dentistry in Pueblo, CO
• Providers in Pueblo, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.