Provider Demographics
NPI:1508023805
Name:ALL KIDS DENTAL PEDIATRICS AND ORTHODONTICS
Entity Type:Organization
Organization Name:ALL KIDS DENTAL PEDIATRICS AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-928-9500
Mailing Address - Street 1:2624 GRAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4676
Mailing Address - Country:US
Mailing Address - Phone:970-928-9500
Mailing Address - Fax:970-928-7467
Practice Address - Street 1:990 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-8527
Practice Address - Country:US
Practice Address - Phone:970-625-9500
Practice Address - Fax:970-928-7467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty