My Local Colorado Dental Practice, LLC

NPI #1891335980 in Englewood, Colorado

Provider Information

NPI Number
1891335980
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
Jan 7, 2020
Last Updated
Jan 7, 2020

Practice Location

Address
5120 S BROADWAY
ZIP Code
80113-9303
Phone
(303) 794-0044

Authorized Official

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

Specialties & Taxonomy Codes

Specialty
Dentist - General PracticeGeneral Practice

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