Provider Demographics
NPI:1255331369
Name:MJOS, DAVID PAUL (DOS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:MJOS
Suffix:
Gender:M
Credentials:DOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 BRIARGATE BLVD
Mailing Address - Street 2:#847
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3449
Mailing Address - Country:US
Mailing Address - Phone:719-531-0636
Mailing Address - Fax:719-531-7640
Practice Address - Street 1:1710 BRIARGATE BLVD
Practice Address - Street 2:#847
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3449
Practice Address - Country:US
Practice Address - Phone:719-531-0636
Practice Address - Fax:719-531-7640
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist