Provider Demographics
NPI:1609100437
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:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ADDARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-638-7673
Mailing Address - Street 1:6071 E WOODMEN RD
Mailing Address - Street 2:STE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2607
Mailing Address - Country:US
Mailing Address - Phone:719-638-7673
Mailing Address - Fax:719-424-4928
Practice Address - Street 1:6071 E WOODMEN RD
Practice Address - Street 2:STE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2607
Practice Address - Country:US
Practice Address - Phone:719-638-7673
Practice Address - Fax:719-424-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-26
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty