Provider Demographics
NPI:1063647584
Name:MONUMENT DENTAL PROFESSIONALS LLC
Entity Type:Organization
Organization Name:MONUMENT DENTAL PROFESSIONALS LLC
Other - Org Name:COMFORT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-484-0043
Mailing Address - Street 1:1258 INTERQUEST PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-4183
Mailing Address - Country:US
Mailing Address - Phone:719-484-0043
Mailing Address - Fax:719-487-3153
Practice Address - Street 1:1258 INTERQUEST PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-4183
Practice Address - Country:US
Practice Address - Phone:719-484-0043
Practice Address - Fax:719-487-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty