| Imagine Braces | |
|
6620 Camden Blvd Fountain CO 80817-2505 | |
| (719) 631-6649 | |
| Not Available |
| Full Name | Imagine Braces |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 6620 Camden Blvd, Fountain, Colorado |
| Authorized Official Name and Position | Warren Johnson (PRESIDENT) |
| Authorized Official Contact | 7194329807 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Imagine Braces 5850 Tutt Center Pt Ste 100 Colorado Springs CO 80922-3520 Ph: (719) 596-3081 | Imagine Braces 6620 Camden Blvd Fountain CO 80817-2505 Ph: (719) 631-6649 |
| NPI Number | 1477188407 |
|---|---|
| Provider Enumeration Date | 03/10/2020 |
| Last Update Date | 08/05/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477188407 | NPI | - | NPPES |
| 1223X0400X | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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