Orchard Springs Dental

Primary specialty

DentistTaxonomy code 122300000X

License

8336 Issued in CO

Legal business name

ORCHARD SPRINGS DENTAL

Practice address

410 Macon Ave
Canon City, CO 81212-3225

Phone

(719) 276-0117

Fax

(719) 276-0653

NPI assigned

Apr 19, 2007

Organization subpart

No

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

Authorized official

Name

Carol Rieg

Title

Manager

Phone

(719) 276-0117

Specialties & licenses 3

Addresses

Other identifiers 2

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194942573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 MACON ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "81212",
            "telephone_number": "719-276-0117",
            "fax_number": "719-276-0653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 MACON AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123225",
            "telephone_number": "719-276-0117",
            "fax_number": "719-276-0653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORCHARD SPRINGS DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RIEG",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "719-276-0117"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "8336",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "106275",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "105973",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "88834042",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17258871",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Canon City, CO
• Providers in Canon City, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.