NPIMap

Organization Active NPI

Colorado Dental Specialist Practice, LLC

  • Periodontics
  • Woodland Park, CO
National Provider Identifier
1366096927
Registry record updated Jul 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
COLORADO DENTAL SPECIALIST PRACTICE, LLC
Practice address
150 Morning Sun Dr Ste 200W
Woodland Park, CO 80863-9160
Phone
(719) 484-8490
NPI assigned
Jul 31, 2019
Organization subpart
Yes
Parent organization
COLORADO DENTAL SPECIALIST PRACTICE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 31, 2019

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

Authorized official

Name
Michelle Johnson
Title
Credentialing Specialists
Phone
(509) 315-8338

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

150 Morning Sun Dr Ste 200W
Woodland Park, CO 80863-9160

Mailing address

150 Morning Sun Dr Ste 200W
Woodland Park, CO 80863-9160
Phone (719) 484-8490

Other names 3

  • All Smiles Orthodontics Doing business as
  • Colorado Dental Specialists Doing business as
  • Colorado Endodontic Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Colorado Dental Specialist Practice LLC29 organizations share this tax ID, including this one
Part of
Colorado Dental Specialist Practice LLC

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Locations

150 Morning Sun Dr
Ste 200W
Woodland Park, CO 80863
Phone (719) 387-0472

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564531200000",
    "number": "1366096927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MORNING SUN DR STE 200W",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808639160",
            "telephone_number": "719-484-8490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MORNING SUN DR STE 200W",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808639160",
            "telephone_number": "719-484-8490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO DENTAL SPECIALIST PRACTICE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLORADO DENTAL SPECIALIST PRACTICE, LLC",
        "enumeration_date": "2019-07-31",
        "last_updated": "2019-07-31",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALISTS",
        "authorized_official_telephone_number": "509-315-8338"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "All Smiles Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colorado Dental Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colorado Endodontic Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodland Park, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; 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.