Community Dental Clinic, Inc.

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

Legal business name

COMMUNITY DENTAL CLINIC, INC.

Practice address

87 Merchant Dr
Montrose, CO 81401-3015

Phone

(970) 252-8896

Fax

(970) 240-3095

NPI assigned

Feb 24, 2006

Organization subpart

No

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

Authorized official

Name

Melanie Hall

Title

Executive Director

Phone

(970) 252-8896

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• The PIC Place Doing business as

Locations

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508112000000",
    "number": "1932175346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87 MERCHANT DR",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814013015",
            "telephone_number": "970-252-8896",
            "fax_number": "970-240-3095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87 MERCHANT DR",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814013015",
            "telephone_number": "970-252-8896",
            "fax_number": "970-240-3095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY DENTAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-24",
        "last_updated": "2017-10-16",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "970-252-8896"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06727841",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL CHP PLUS",
            "identifier": "2528896",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The PIC Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community Dental Clinic Inc.
• Community Medical Group, LLC
• Community Options, Inc.
• Community Options, Inc.
• Community Options, Inc.
• Community Options, Inc.

• All providers in Montrose, CO
• Public Health Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.