| My Local Colorado Dental Practice, Llc | |
|
10461 Park Meadows Dr Bldg 4 Lone Tree CO 80124-5306 | |
| (303) 534-2626 | |
| Not Available |
| Full Name | My Local Colorado Dental Practice, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10461 Park Meadows Dr Bldg 4, Lone Tree, Colorado |
| Authorized Official Name and Position | Michelle Johnson (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 5093158338 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| My Local Colorado Dental Practice, Llc 10461 Park Meadows Dr Bldg 4 Lone Tree CO 80124-5306 Ph: (303) 534-2626 | My Local Colorado Dental Practice, Llc 10461 Park Meadows Dr Bldg 4 Lone Tree CO 80124-5306 Ph: (303) 534-2626 |
| NPI Number | 1356995021 |
|---|---|
| Provider Enumeration Date | 07/30/2019 |
| Last Update Date | 07/30/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356995021 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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