My Local Colorado Dental Practice, LLC

NPI #1821642596 in Pueblo, Colorado

Provider Information

NPI Number: 1821642596
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 30, 2019

Practice Location

Address: 1800 FORTINO BLVD
City: Pueblo
State: Colorado
ZIP Code: 81008-1890
Phone: (719) 545-1400

Authorized Official

Name: MICHELLE JOHNSON
Title: CREDENTIALING SPECIALIST
Phone: (509) 315-8338

Specialties & Taxonomy Codes

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

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