NPIMap

Organization Active NPI

Mountain Dental PC

Doing business as Mountain Dental

  • Dentist
  • Broomfield, CO
National Provider Identifier
1922244193
Registry record updated Dec 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MOUNTAIN DENTAL PC
Doing business as
Mountain Dental
Practice address
300 Nickel St Ste 11
Broomfield, CO 80020-2097
Phone
(303) 635-1816
NPI assigned
Dec 18, 2008
Organization subpart
Yes
Parent organization
MOUNTAIN DENTAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 18, 2008

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

Authorized official

Name
Lori Pelke
Title
Professional Services
Phone
(715) 926-5050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

300 Nickel St Ste 11
Broomfield, CO 80020-2097

Mailing address

300 Nickel St Ste 11
Broomfield, CO 80020-2097
Phone (303) 635-1816

Other names 1

  • Mountain Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mountain Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

300 Nickel St
Ste 11
Broomfield, CO 80020
Phone (303) 635-1816

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1229558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229558400000",
    "number": "1922244193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 NICKEL ST STE 11",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800202097",
            "telephone_number": "303-635-1816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 NICKEL ST STE 11",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800202097",
            "telephone_number": "303-635-1816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN DENTAL PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAIN DENTAL INC",
        "enumeration_date": "2008-12-18",
        "last_updated": "2008-12-18",
        "status": "A",
        "authorized_official_last_name": "PELKE",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "PROFESSIONAL SERVICES",
        "authorized_official_telephone_number": "715-926-5050"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broomfield, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2008; 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.