NPIMap

Organization Active NPI

Hero Dental of Springs PC

Doing business as Academy Kids Dental and Vision

  • General Practice Dentistry
  • Colorado Springs, CO
National Provider Identifier
1558765339
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
HERO DENTAL OF SPRINGS PC
Doing business as
Academy Kids Dental and Vision
Practice address
883 N Academy Blvd
Colorado Springs, CO 80909-8307
Phone
(719) 442-0071
Fax
(719) 473-5303
NPI assigned
Oct 22, 2014
Last updated
Nov 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

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

Addresses

Primary practice location

883 N Academy Blvd
Colorado Springs, CO 80909-8307

Mailing address

2221 E Bijou St Ste 100
Colorado Springs, CO 80909-8009
Phone (719) 955-8896

Other identifiers 1

IdentifierTypeStateIssuer
45275025MedicaidCO

Other names 1

  • Academy Kids Dental and Vision Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hero Dental of Springs PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1413936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1558765339",
    "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": "883 N ACADEMY BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809098307",
            "telephone_number": "719-442-0071",
            "fax_number": "719-473-5303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERO DENTAL OF SPRINGS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-22",
        "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 SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45275025",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Academy Kids Dental and Vision",
            "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 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.