Provider Demographics
NPI:1568075489
Name:OPEN AND AFFORDABLE DENTAL CS NORTH PLLC
Entity Type:Organization
Organization Name:OPEN AND AFFORDABLE DENTAL CS NORTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:STOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-593-9182
Mailing Address - Street 1:6375 LEHMAN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1427
Mailing Address - Country:US
Mailing Address - Phone:719-593-9182
Mailing Address - Fax:
Practice Address - Street 1:6375 LEHMAN DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1427
Practice Address - Country:US
Practice Address - Phone:719-593-9182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental