NPIMap

Organization Active NPI

Monument Child Dental & Orthodontic Specialists PC

  • Pediatric Dentistry
  • Colorado Springs, CO
National Provider Identifier
1992063176
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
9665 Issued in CO
Legal business name
MONUMENT CHILD DENTAL & ORTHODONTIC SPECIALISTS PC
Doing business as
Erickson Pediatric Dentistry & Orthodontics
Practice address
850 Sky Vista Point
Colorado Springs, CO 80921-1400
Phone
(719) 488-1101
Fax
(719) 488-1115
NPI assigned
Apr 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Authorized official

Name
Dawn Rush
Title
Business Manager
Phone
(719) 282-6666

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 9665 CO Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X 9665 CO

Addresses

Primary practice location

850 Sky Vista Point
Colorado Springs, CO 80921-1400

Mailing address

9334 Grand Cordera Pkwy
Colorado Springs, CO 80924-7000
Phone (719) 282-6666

Other identifiers 2

IdentifierTypeStateIssuer
29102251MedicaidCO
86708350MedicaidCO

Other names 1

  • Erickson Pediatric Dentistry & Orthodontics Doing business as

National Provider Directory

National Provider Directory

Locations

850 Sky Vista Pt
Colorado Springs, CO 80921
Phone (719) 282-6666

16055 Old Forest Pt
Ste 202
Monument, CO 80132

Practitioners & affiliated clinicians

Practitioners 5

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": "1335312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656547200000",
    "number": "1992063176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9334 GRAND CORDERA PKWY",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809247000",
            "telephone_number": "719-282-6666",
            "fax_number": "719-203-5477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 SKY VISTA POINT",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809211400",
            "telephone_number": "719-488-1101",
            "fax_number": "719-488-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONUMENT CHILD DENTAL & ORTHODONTIC SPECIALISTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-25",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A",
        "authorized_official_last_name": "RUSH",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "719-282-6666"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "9665",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CO",
            "license": "9665",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "29102251",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "86708350",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Erickson Pediatric Dentistry & Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Erickson Pediatric Dentistry & Orthodontics",
            "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 Jun 30, 2022; 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.