| Medicaid Dental Home | |
|
2125 E La Salle St Colorado Springs CO 80909-2274 | |
| (719) 310-3315 | |
| Not Available |
| Full Name | Medicaid Dental Home |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 2125 E La Salle St, Colorado Springs, Colorado |
| Authorized Official Name and Position | Michelle Vacha (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7193382195 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Medicaid Dental Home 2604 Flintridge Dr Colorado Springs CO 80918-4408 Ph: (719) 338-2195 | Medicaid Dental Home 2125 E La Salle St Colorado Springs CO 80909-2274 Ph: (719) 310-3315 |
| NPI Number | 1336570167 |
|---|---|
| Provider Enumeration Date | 12/04/2013 |
| Last Update Date | 12/04/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336570167 | NPI | - | NPPES |
| 84887761 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | 8109 (Colorado) | Primary |
| 124Q00000X | Dental Hygienist | 903783 (Colorado) | Secondary |
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My Local Colorado Dental Practice, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3715 Bloomington St Unit 160, Colorado Springs, CO 80922 Phone: 719-599-0665 | |
Colorado Dental Professionals, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 745 W Baptist Rd, Colorado Springs, CO 80921 Phone: 719-203-7375 | |
Co Specialty Dental Services Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 S Tejon St Ste 200, Colorado Springs, CO 80903 Phone: 719-596-3113 | |
Rand L. Redfern, Dds, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 669 Citadel Dr E, Colorado Springs, CO 80909 Phone: 719-599-9090 Fax: 719-573-9091 | |
Premier Dental Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 685 Citadel Dr E, Suite 302, Colorado Springs, CO 80909 Phone: 719-596-1011 Fax: 719-596-6748 |