Eden Dental Pueblo PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

EDEN DENTAL PUEBLO PC

Doing business as

Implant & Periodontic Specialists of Pueblo

Practice address

2041 Pepper LN
Pueblo, CO 81005-3276

Phone

(719) 696-9009

NPI assigned

Sep 10, 2019

Last updated

Nov 12, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Robert Herrera

Title

Business Manager

Phone

(760) 978-8527

Specialties & licenses 2

Addresses

Other names 1

• Implant & Periodontic Specialists of Pueblo Doing business as

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605139200000",
    "number": "1154970366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 PEPPER LN",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810053276",
            "telephone_number": "719-696-9009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 PEPPER LN",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810053276",
            "telephone_number": "719-696-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN DENTAL PUEBLO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-10",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A",
        "authorized_official_last_name": "HERRERA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "760-978-8527"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Implant & Periodontic Specialists of Pueblo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kerri Eckerson
• Sheila Ann Eckerson
• Danielle Eckert
• Alaina Marie Eckhardt
• Kari Ann Stenerson Eckman, D.O.
• Krystal G Edwards
• Nevis Ann Edwards
• Rachel Edwards, RN
• Shannon A Egan, DPT
• Jon Edward Eggert, EDD

• Periodontics in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Periodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; 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.