Provider Demographics
NPI:1790167369
Name:CORONA PASS DENTAL PLLC
Entity Type:Organization
Organization Name:CORONA PASS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRESCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-393-2517
Mailing Address - Street 1:PO BOX 3292
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80482-3292
Mailing Address - Country:US
Mailing Address - Phone:970-726-8290
Mailing Address - Fax:970-726-8051
Practice Address - Street 1:21 KINGS CROSSING RD
Practice Address - Street 2:SIUTE 206
Practice Address - City:WINTER PARK
Practice Address - State:CO
Practice Address - Zip Code:80482
Practice Address - Country:US
Practice Address - Phone:970-726-8290
Practice Address - Fax:970-726-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty