Pueblo Dental & Braces

Primary specialty

DentistTaxonomy code 122300000X

License

DEN 202339 Issued in CO

Legal business name

PUEBLO DENTAL & BRACES

Practice address

1345 S Pueblo Blvd
Pueblo, CO 81005-1508

Phone

(623) 910-5569

NPI assigned

May 12, 2017

Organization subpart

No

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

Authorized official

Name

Michael Hall

Title

Dentist/ Owner

Phone

(801) 602-0691

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1494547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494547200000",
    "number": "1891222402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4542 VALLEYBROOK DR",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801306965",
            "telephone_number": "623-910-5569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 S PUEBLO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810051508",
            "telephone_number": "623-910-5569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO DENTAL & BRACES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-12",
        "last_updated": "2017-05-12",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DENTIST/ OWNER",
        "authorized_official_telephone_number": "801-602-0691"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN 202339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• Dentist in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2017; 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.