NPIMap

Organization Active NPI

My Local Colorado Dental Practice, LLC

  • General Practice Dentistry
  • Arvada, CO
National Provider Identifier
1417501180
Registry record updated Jul 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MY LOCAL COLORADO DENTAL PRACTICE, LLC
Practice address
8721 Wadsworth Blvd
Arvada, CO 80003-0929
Phone
(720) 605-4302
NPI assigned
Jul 30, 2019
Organization subpart
Yes
Parent organization
MY LOCAL COLORADO DENTAL PRACTICE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 23, 2021

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

Authorized official

Name
Gregory Kostelac
Title
Credentialing Specialist
Phone
(719) 372-5605

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

8721 Wadsworth Blvd
Arvada, CO 80003-0929

Mailing address

8721 Wadsworth Blvd
Arvada, CO 80003-0929
Phone (720) 605-4302

Other names 1

  • Standley Lake Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
My Local Colorado Dental Practice LLC40 organizations share this tax ID, including this one
Part of
My Local Colorado Dental Practice LLC

Other organizations with this tax ID 39

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

View all 39

Locations

8721 Wadsworth Blvd
Arvada, CO 80003
Phone (720) 605-4302

8410 Wadsworth Blvd
Unit G
Arvada, CO 80003
Phone (303) 463-8570

NPI Registry JSON

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

{
    "created_epoch": "1564444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626998400000",
    "number": "1417501180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8721 WADSWORTH BLVD",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800030929",
            "telephone_number": "720-605-4302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8721 WADSWORTH BLVD",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800030929",
            "telephone_number": "720-605-4302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY LOCAL COLORADO DENTAL PRACTICE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MY LOCAL COLORADO DENTAL PRACTICE, LLC",
        "enumeration_date": "2019-07-30",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-07",
        "status": "A",
        "authorized_official_last_name": "KOSTELAC",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "719-372-5605"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Standley Lake Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arvada, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.