NPIMap

Organization Active NPI

Colorado Dental Specialist Practice, LLC

  • Periodontics
  • Lone Tree, CO
National Provider Identifier
1487208013
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
10461 Park Meadows Dr BLDG 4
Lone Tree, CO 80124-5306
Phone
(303) 534-2626
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 Specialist
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

10461 Park Meadows Dr BLDG 4
Lone Tree, CO 80124-5306

Mailing address

10461 Park Meadows Dr BLDG 4
Lone Tree, CO 80124-5306
Phone (303) 534-2626

Other names 3

  • Colorado Dental Specialists Doing business as
  • Colorado Endodontic Group Doing business as
  • Colorado Orthodontic 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

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": "1487208013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10461 PARK MEADOWS DR BLDG 4",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801245306",
            "telephone_number": "303-534-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10461 PARK MEADOWS DR BLDG 4",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801245306",
            "telephone_number": "303-534-2626"
        }
    ],
    "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 SPECIALIST",
        "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": "Colorado Dental Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colorado Endodontic Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colorado Orthodontic Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lone Tree, 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.