NPIMap

Organization Active NPI

Advantage Dental Group

  • Dentist
  • Pueblo, CO
National Provider Identifier
1205276128
Registry record updated Jun 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
105682 Issued in CO
Legal business name
ADVANTAGE DENTAL GROUP
Practice address
1800 Fortino Blvd Unit 1
Pueblo, CO 81008-1891
Phone
(719) 545-1400
Fax
(719) 545-5153
NPI assigned
Jun 25, 2013
Last updated
Jun 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2013

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

Authorized official

Name
Eric L. Berry, DDSNPI 1356349682
Title
Owner
Phone
(719) 545-1400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 105682 CO Primary

Addresses

Primary practice location

1800 Fortino Blvd Unit 1
Pueblo, CO 81008-1891

Mailing address

1800 Fortino Blvd Unit 1
Pueblo, CO 81008-1891
Phone (719) 545-1400

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372118400000",
    "number": "1205276128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 FORTINO BLVD UNIT 1",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081891",
            "telephone_number": "719-545-1400",
            "fax_number": "719-545-5153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 FORTINO BLVD UNIT 1",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081891",
            "telephone_number": "719-545-1400",
            "fax_number": "719-545-5153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-25",
        "last_updated": "2013-06-25",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-545-1400",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "105682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; 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.