Academy Kids Dental Center PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ACADEMY KIDS DENTAL CENTER PC

Practice address

2436 S Academy Blvd
Colorado Springs, CO 80916-2408

Phone

(719) 391-2336

Fax

(719) 391-1625

NPI assigned

Jul 2, 2006

Organization subpart

No

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

Authorized official

Name

Shaun Urbanozo

Title

Credentialing Manager

Phone

(719) 323-2362

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Academy Kids Dental, Vision and Orthodontics Doing business as

Tax ID family

Academy Kids Dental Center PC2 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.

• Academy Kids Dental Center PC

  • General Practice Dentistry
  • Colorado Springs, CO
  • NPI 1700489903
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Academy Kids Dental Center PC

  • General Practice Dentistry
  • Colorado Springs, CO
  • NPI 1700489903
  NPPES parent name

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1487683330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 E BIJOU ST STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809098009",
            "telephone_number": "719-955-8896",
            "fax_number": "719-955-3470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2436 S ACADEMY BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809162408",
            "telephone_number": "719-391-2336",
            "fax_number": "719-391-1625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADEMY KIDS DENTAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "URBANOZO",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "719-323-2362"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "7992",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA ID",
            "identifier": "1630472",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "66286026",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Academy Kids Dental, Vision and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Academic Pain Physicians of Colorado Springs
• Academy Dermatology PC
• Academy Ear Nose Throat /Allergy Clinic
• Academy Heights Foot Clinic PC
• Academy Heights Foot Clinic PC
• Academy Kids Dental Center PC
• Academy Kids Vision Center LLC
• Academy Kids Vision Center LLC
• Academy Laser Dentistry PC
• Academy Vision Science Clinic PC

• General Practice Dentistry in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; 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.