Woodmoor Family Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

WOODMOOR FAMILY DENTISTRY

Practice address

1777 Lake Woodmoor Dr
Monument, CO 80132-9074

Phone

(719) 488-3014

Fax

(719) 488-3015

NPI assigned

Feb 18, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Andrew Wilson Dethloff, DDSNPI 1548893928

Title

Owner/Dentist

Phone

(719) 488-3014

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Woodmoor Dental Former legal business name

Practitioners 1

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

• Andrew Wilson Dethloff, DDS. MA

  • General Practice Dentistry
  • Monument, CO
  • NPI 1548893928
  NPD Authorized official

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1346833571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 LAKE WOODMOOR DR",
            "city": "MONUMENT",
            "state": "CO",
            "postal_code": "801329074",
            "telephone_number": "719-488-3014",
            "fax_number": "719-488-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 LAKE WOODMOOR DR",
            "city": "MONUMENT",
            "state": "CO",
            "postal_code": "801329074",
            "telephone_number": "719-488-3014",
            "fax_number": "719-488-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODMOOR FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-18",
        "last_updated": "2021-02-18",
        "certification_date": "2021-01-29",
        "status": "A",
        "authorized_official_last_name": "DETHLOFF",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "WILSON",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "719-488-3014",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000181282",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodmoor Dental",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kathryn M Williams, CCC-SLP
• Deborah L Williamson, LCSW
• Jeffrey Witt
• Michael Woodley, R.PH.
• Woodmoor Dental
• Lauren T Woolf
• Kelly Wormald, DPT
• Shannon Wright, PMHNP-BC, FNP-C
• Yasmine Wright, ATC
• Jacey Yancey

• Dental Clinic/Center in Monument, CO
• Providers in Monument, CO by specialty
• Dental Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; 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.