Southmoor Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

04949 Issued in CO

Legal business name

SOUTHMOOR PEDIATRIC DENTISTRY

Practice address

6850 E Hampden Ave
Denver, CO 80224-3024

Phone

(303) 758-6057

Fax

(303) 692-9655

NPI assigned

Dec 12, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Bradley R. Smith

Title

President

Phone

(303) 799-1872

Specialties & licenses 1

Addresses

Practitioners 1

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

• John M. Rubenstrunk, D.D.S.,M.S

  • Pediatric Dentistry
  • Centennial, CO
  • NPI 1912004383
  NPD

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

{
    "created_epoch": "1134345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610323200000",
    "number": "1811972094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6850 E HAMPDEN AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802243024",
            "telephone_number": "303-758-6057",
            "fax_number": "303-692-9655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6850 E HAMPDEN AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802243024",
            "telephone_number": "303-758-6057",
            "fax_number": "303-692-9655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHMOOR PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-12",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-799-1872",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "04949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeast Denver Dental Associates PC
• Southeast Denver Pediatrics, PC
• Southeast Family Practice Associates P C
• Brenda Marie Southerly, COTA
• Southern California Kidney Care, PC
• Southport Healthcare Inc.
• Charles Southwell, D.C.
• Danielle Marie Southwell, RN
• Southwest Adams County Fire Protection District
• Southwest Neuromonitoring LLC

• Pediatric Dentistry in Denver, CO
• Providers in Denver, CO by specialty
• Pediatric Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; 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.