My Local Colorado Dental Practice, LLC

NPI #1417501180 in Arvada, Colorado

Provider Information

NPI Number: 1417501180
Entity Type: Organization
Organization Name: My Local Colorado Dental Practice, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: MY LOCAL COLORADO DENTAL PRACTICE, LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Jul 30, 2019
Last Updated: Jul 23, 2021

Practice Location

Address: 8721 WADSWORTH BLVD
City: Arvada
State: Colorado
ZIP Code: 80003-0929
Phone: (720) 605-4302

Authorized Official

Name: GREGORY KOSTELAC
Title: CREDENTIALING SPECIALIST
Phone: (719) 372-5605

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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