Provider Demographics
NPI:1215045042
Name:CENTER FOR DENTAL EXCELLENCE, INC
Entity Type:Organization
Organization Name:CENTER FOR DENTAL EXCELLENCE, INC
Other - Org Name:COLORADO SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-249-6955
Mailing Address - Street 1:601 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4207
Mailing Address - Country:US
Mailing Address - Phone:970-249-6955
Mailing Address - Fax:970-249-7309
Practice Address - Street 1:601 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4207
Practice Address - Country:US
Practice Address - Phone:970-249-6955
Practice Address - Fax:970-249-7309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1053871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11636319Medicaid