Medicaid Dental Home
NPI #1336570167 in Colorado Springs, Colorado
Provider Information
- NPI Number
- 1336570167
- Entity Type
- Organization
- Organization Name
- Medicaid Dental Home
- Primary Specialty
- Dentist - Dental Public Health
- Enumeration Date
- Dec 4, 2013
- Last Updated
- Dec 4, 2013
Practice Location
- Address
- 2125 E LA SALLE ST
- City
- Colorado Springs
- State
- Colorado
- ZIP Code
- 80909-2274
- Phone
- (719) 310-3315
Authorized Official
- Name
- MICHELLE VACHA, RDH
- Title
- EXECUTIVE DIRECTOR
- Phone
- (719) 338-2195
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dental Hygienist |
| Dentist - Dental Public Health — Dental Public Health |
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