Basic Information
| Provider Information | |||||||||
| NPI: | 1881338234 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CO SPECIALTY DENTAL SERVICES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1610 54TH AVE N STE 205 | ||||||||
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| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372091442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5046380303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4500 CHERRY CREEK DRIVE SOUTH | ||||||||
| Address2: | STE 840 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802468024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033771148 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2022 | ||||||||
| LastUpdateDate: | 04/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | DASCH | ||||||||
| AuthorizedOfficialFirstName: | CHARLOTTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PROVIDER RELATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5046380303 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CO SPECIALTY DENTAL SERVICES PLLC | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.