Pueblo Dental Center of Pueblo

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7989 Issued in CO

Legal business name

PUEBLO DENTAL CENTER OF PUEBLO

Practice address

1700 N Salem Ave
Suite B
Pueblo, CO 81001-2846

Phone

(719) 582-4222

Fax

(719) 597-7507

NPI assigned

Sep 5, 2013

Organization subpart

Yes

Parent organization

PRESTIGE DENTAL CENTERS LLCAs reported in NPPES

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

Authorized official

Name

Tina Comer

Title

Office Manager

Phone

(719) 582-4222

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Prestige Dental LLC

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

{
    "created_epoch": "1378339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378339200000",
    "number": "1699100982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3208 N ACADEMY BLVD",
            "address_2": "SUITE 110",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175161",
            "telephone_number": "719-597-3700",
            "fax_number": "719-597-7507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N SALEM AVE",
            "address_2": "SUITE B",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810012846",
            "telephone_number": "719-582-4222",
            "fax_number": "719-597-7507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO DENTAL CENTER OF PUEBLO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESTIGE DENTAL CENTERS LLC",
        "enumeration_date": "2013-09-05",
        "last_updated": "2013-09-05",
        "status": "A",
        "authorized_official_last_name": "COMER",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "719-582-4222"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "7989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pueblo Community Health Center, Inc
• Pueblo Community Resources Co. Inc.
• Pueblo County
• Pueblo County School Dist 70
• Pueblo Dental & Braces
• Pueblo Dental Services LLC
• Pueblo Department of Public Health and Environment
• Pueblo Diversified Industries, Inc.
• Pueblo Ear Nose & Throat Specialist
• Pueblo Endodontic Asso LLC

• General Practice Dentistry in Pueblo, CO
• Providers in Pueblo, 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 Sep 5, 2013; 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.