Provider Demographics
NPI:1164790804
Name:COLORADO DENTAL, PC
Entity Type:Organization
Organization Name:COLORADO DENTAL, PC
Other - Org Name:DENTAL CENTER OF STEAMBOAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KRIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-294-2323
Mailing Address - Street 1:1615 32ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4072
Mailing Address - Country:US
Mailing Address - Phone:319-294-2323
Mailing Address - Fax:319-395-6715
Practice Address - Street 1:940 CENTRAL PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8816
Practice Address - Country:US
Practice Address - Phone:970-871-4611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA74021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty