Woodland Park Dental Professional LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

WOODLAND PARK DENTAL PROFESSIONAL LLC

Practice address

150 Morning Sun Dr
Suite 200W
Woodland Park, CO 80863-9160

Phone

(719) 484-8490

Fax

(888) 790-7062

NPI assigned

Aug 8, 2013

Organization subpart

No

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

Authorized official

Name

Andrew Peak

Title

Ceo

Phone

(719) 484-8490

Specialties & licenses 5

Addresses

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

{
    "created_epoch": "1375920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375920000000",
    "number": "1811329121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MORNING SUN DR",
            "address_2": "SUITE 200W",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808639160",
            "telephone_number": "719-484-8490",
            "fax_number": "888-790-7062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MORNING SUN DR",
            "address_2": "SUITE 200W",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808639160",
            "telephone_number": "719-484-8490",
            "fax_number": "888-790-7062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAND PARK DENTAL PROFESSIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-08",
        "last_updated": "2013-08-08",
        "status": "A",
        "authorized_official_last_name": "PEAK",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "719-484-8490"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Woodland Park, CO
• Providers in Woodland Park, 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 Aug 8, 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.