Advantage Dental Group

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

Organization subpart

No

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

Authorized official

Name

Eric L. Berry, DDS

Title

Owner

Phone

(719) 545-1400

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael E Allen, D.M.D.

  • Dentist
  • Pueblo, CO
  • NPI 1346608197
  NPD (past)
• Timothy David Petty, DMD

  • General Practice Dentistry
  • Pueblo, CO
  • NPI 1699418921
  NPD (past)
• Morgan Williams, DMD

  • Dentist
  • Pueblo, CO
  • NPI 1912812934
  NPD (past)

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": []
}

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• 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.