NPIMap

Organization Active NPI

My Local Colorado Dental Practice, LLC

  • General Practice Dentistry
  • Colorado Springs, CO
National Provider Identifier
1639770449
Registry record updated Nov 6, 2020
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
10807 New Allegiance Dr Ste 465
Colorado Springs, CO 80921-3722
Phone
(719) 548-9393
NPI assigned
Nov 6, 2020
Organization subpart
Yes
Parent organization
MY LOCAL COLORADO DENTAL PRACTICE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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 1

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

Addresses

Primary practice location

10807 New Allegiance Dr Ste 465
Colorado Springs, CO 80921-3722

Mailing address

10807 New Allegiance Dr Ste 465
Colorado Springs, CO 80921-3722

Other names 1

  • Exceptional Smiles Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ins@peakdentalservices.com

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1604620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604620800000",
    "number": "1639770449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10807 NEW ALLEGIANCE DR STE 465",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809213722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10807 NEW ALLEGIANCE DR STE 465",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809213722",
            "telephone_number": "719-548-9393"
        }
    ],
    "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": "2020-11-06",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "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": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ins@peakdentalservices.com",
            "affiliation": "N",
            "address_1": "10807 New Allegiance Dr Ste 465",
            "city": "Colorado Springs",
            "state": "CO",
            "country_code": "US",
            "postal_code": "809213722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Exceptional Smiles",
            "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 6, 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.