NPIMap

Organization Active NPI

Palmer Park Dentistry, PLLC

  • General Practice Dentistry
  • Colorado Springs, CO
National Provider Identifier
1487467684
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PALMER PARK DENTISTRY, PLLC
Practice address
3208 N Academy Blvd Ste 140
Colorado Springs, CO 80917-5111
Phone
(719) 301-5300
Fax
(719) 301-5303
NPI assigned
Jan 30, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Authorized official

Name
Nick Sundiam
Title
Credentialing Manager
Phone
(719) 301-5300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3208 N Academy Blvd Ste 140
Colorado Springs, CO 80917-5111

Mailing address

3208 N Academy Blvd Ste 140
Colorado Springs, CO 80917-5111
Phone (719) 301-5300

Other names 1

  • Palmer Park Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Palmer Park Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1738195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738195200000",
    "number": "1487467684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3208 N ACADEMY BLVD STE 140",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175111",
            "telephone_number": "719-301-5300",
            "fax_number": "719-301-5303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3208 N ACADEMY BLVD STE 140",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175111",
            "telephone_number": "719-301-5300",
            "fax_number": "719-301-5303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMER PARK DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "SUNDIAM",
        "authorized_official_first_name": "NICK",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "719-301-5300"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palmer Park Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; 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.