NPIMap

Organization Active NPI

Evergreen Dental Partners LLP

Doing business as Comfort Dental Evergreen

  • Dentist
  • Evergreen, CO
National Provider Identifier
1356621122
Registry record updated Aug 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8121 Issued in CO
Legal business name
EVERGREEN DENTAL PARTNERS LLP
Doing business as
Comfort Dental Evergreen
Practice address
1232 Bergen Pkwy
Evergreen, CO 80439-9573
Phone
(303) 674-6070
NPI assigned
Aug 24, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2011

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

Authorized official

Name
Dr. Gary D Rotolo, DDSNPI 1962682567
Title
Partner
Phone
(303) 674-6070

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 8121 CO Primary

Addresses

Primary practice location

1232 Bergen Pkwy
Evergreen, CO 80439-9573

Mailing address

1232 Bergen Pkwy
Evergreen, CO 80439-9573
Phone (303) 674-6070

Other identifiers 1

IdentifierTypeStateIssuer
69708533MedicaidCO

Other names 1

  • Comfort Dental Evergreen Doing business as

National Provider Directory

National Provider Directory

Locations

1232 Bergen Pkwy
Evergreen, CO 80439
Phone (303) 674-6070

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314144000000",
    "number": "1356621122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1232 BERGEN PKWY",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804399573",
            "telephone_number": "303-674-6070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1232 BERGEN PKWY",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804399573",
            "telephone_number": "303-674-6070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN DENTAL PARTNERS LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-24",
        "last_updated": "2011-08-24",
        "status": "A",
        "authorized_official_last_name": "ROTOLO",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "303-674-6070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "8121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "69708533",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comfort Dental Evergreen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evergreen, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; 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.