Provider Demographics
NPI:1235728387
Name:ROCKY MOUNTAIN PEDIATRIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRESSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-638-7673
Mailing Address - Street 1:6071 E WOODMEN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2609
Mailing Address - Country:US
Mailing Address - Phone:719-638-7673
Mailing Address - Fax:719-424-4928
Practice Address - Street 1:12225 VOYAGER PKWY STE 6
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3754
Practice Address - Country:US
Practice Address - Phone:719-638-7673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN PEDIATRIC DENTISTRY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty