Provider Demographics
NPI:1215357934
Name:MOTOR MOUTH
Entity Type:Organization
Organization Name:MOTOR MOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDH
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-572-5853
Mailing Address - Street 1:6985 HOLT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-1608
Mailing Address - Country:US
Mailing Address - Phone:719-572-5853
Mailing Address - Fax:
Practice Address - Street 1:6985 HOLT DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-1608
Practice Address - Country:US
Practice Address - Phone:719-572-5853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO903404261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental