Blue Mesa Dental

Primary specialty

DentistTaxonomy code 122300000X

License

9054 Issued in CO

Legal business name

BLUE MESA DENTAL

Practice address

8100 S Quebec St
St a 15
Englewood, CO 80112

Phone

(720) 489-9800

Fax

(720) 489-9813

NPI assigned

Jan 19, 2007

Organization subpart

No

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

Authorized official

Name

Marissa Anne Nicholson

Title

Office Manager

Phone

(720) 489-9800

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972656403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 S QUEBEC ST",
            "address_2": "ST A 15",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "80112",
            "telephone_number": "720-489-9800",
            "fax_number": "720-489-9813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8100 S QUEBEC ST",
            "address_2": "ST A 15",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "80112",
            "telephone_number": "720-489-9800",
            "fax_number": "720-489-9813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE MESA DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NICHOLSON",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "720-489-9800"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "9054",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "6619",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.