NPIMap

Organization Active NPI

Colorado Dental Professionals, LLC

Doing business as Sangre de Cristo Dental Care

  • General Practice Dentistry
  • Pueblo West, CO
National Provider Identifier
1700449436
Registry record updated Jul 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
COLORADO DENTAL PROFESSIONALS, LLC
Doing business as
Sangre de Cristo Dental Care
Practice address
904 Hailey LN Ste a
Pueblo West, CO 81007-4456
Phone
(719) 225-1009
Fax
(888) 847-1729
NPI assigned
Apr 18, 2019
Last updated
Jul 18, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
COLORADO DENTAL PROFESSIONALS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 18, 2019

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

Authorized official

Name
Jessica Britt
Title
Credentialing Coordinator
Phone
(217) 540-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

904 Hailey LN Ste a
Pueblo West, CO 81007-4456

Mailing address

904 Hailey LN Ste a
Pueblo West, CO 81007-4456
Phone (719) 470-6356

Other names 1

  • Sangre de Cristo Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Colorado Dental Professionals LLC44 organizations share this tax ID, including this one
Part of
Colorado Dental Professionals LLC

Other organizations with this tax ID 43

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

View all 43

Locations

904 E Hailey Ln
Ste A
Pueblo West, CO 81007
Phone (719) 225-1009

NPI Registry JSON

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

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1700449436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 HAILEY LN STE A",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810074456",
            "telephone_number": "719-470-6356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 HAILEY LN STE A",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810074456",
            "telephone_number": "719-225-1009",
            "fax_number": "888-847-1729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO DENTAL PROFESSIONALS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLORADO DENTAL PROFESSIONALS, LLC",
        "enumeration_date": "2019-04-18",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "BRITT",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sangre de Cristo Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sangre de Cristo Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo West, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.