Provider Demographics
NPI:1801027925
Name:JOHN N. ORDAHL DDS MS
Entity Type:Organization
Organization Name:JOHN N. ORDAHL DDS MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:719-596-3098
Mailing Address - Street 1:3505 AUSTIN BLUFFS PKWY STE 215
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5754
Mailing Address - Country:US
Mailing Address - Phone:719-596-3098
Mailing Address - Fax:719-596-3099
Practice Address - Street 1:3505 AUSTIN BLUFFS PKWY STE 215
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5754
Practice Address - Country:US
Practice Address - Phone:719-596-3098
Practice Address - Fax:719-596-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5462261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02054625Medicaid