Southpark Dental Group LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTHPARK DENTAL GROUP LLC

Practice address

3721 Campfire Rd
Hartsel, CO 80449

Phone

(719) 648-2530

NPI assigned

Aug 10, 2018

Last updated

Aug 20, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. James E Caldwell, DDSNPI 1063854321

Title

Owner

Phone

(719) 648-2530

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, and the practitioner matching its NPPES authorized official.

• James E Caldwell, DDS

  • Public Health Dentistry
  • Fairplay, CO
  • NPI 1063854321
  NPD (past) Authorized official

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

{
    "created_epoch": "1533859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534723200000",
    "number": "1861971772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3721 CAMPFIRE RD",
            "city": "HARTSEL",
            "state": "CO",
            "postal_code": "804498611",
            "telephone_number": "719-648-2530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3721 CAMPFIRE RD",
            "city": "HARTSEL",
            "state": "CO",
            "postal_code": "80449",
            "telephone_number": "719-648-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPARK DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-10",
        "last_updated": "2018-08-20",
        "status": "A",
        "authorized_official_last_name": "CALDWELL",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-648-2530",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; 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.