NPIMap

Organization Active NPI

Colorado Dental Professionals, LLC

Doing business as Lodge Dental Care

  • General Practice Dentistry
  • Colorado Springs, CO
National Provider Identifier
1932909611
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
COLORADO DENTAL PROFESSIONALS, LLC
Doing business as
Lodge Dental Care
Practice address
13590 Roller Coaster Rd
Ste 100
Colorado Springs, CO 80921-2155
Phone
(719) 623-1710
Fax
(719) 623-1726
NPI assigned
Mar 13, 2025
Organization subpart
Yes
Parent organization
COLORADO DENTAL PROFESSIONALS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

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

Authorized official

Name
Hillary Thull
Title
Credentialing Coordinator
Phone
(217) 540-8946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

13590 Roller Coaster Rd
Ste 100
Colorado Springs, CO 80921-2155

Mailing address

13590 Roller Coaster Rd
Ste 100
Colorado Springs, CO 80921-2155

Other names 1

  • Lodge Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Colorado Dental Professionals LLC44 organizations share this tax ID, including this one
Part of
Colorado Dental Professionals LLC

Other organizations with this tax ID 43

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

View all 43

Practitioners & affiliated clinicians

Practitioners 1

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": "1741824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741824000000",
    "number": "1932909611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13590 ROLLER COASTER RD",
            "address_2": "STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809212155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13590 ROLLER COASTER RD",
            "address_2": "STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809212155",
            "telephone_number": "719-623-1710",
            "fax_number": "719-623-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO DENTAL PROFESSIONALS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLORADO DENTAL PROFESSIONALS, LLC",
        "enumeration_date": "2025-03-13",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-12",
        "status": "A",
        "authorized_official_last_name": "THULL",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8946"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lodge Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; 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.