Provider Demographics
NPI:1841582210
Name:THE DOWNTOWN DENTIST
Entity Type:Organization
Organization Name:THE DOWNTOWN DENTIST
Other - Org Name:JULIA A. ROHLEDER, DMD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROHLEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-260-0216
Mailing Address - Street 1:105 N TEJON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1405
Mailing Address - Country:US
Mailing Address - Phone:719-260-0216
Mailing Address - Fax:719-227-1853
Practice Address - Street 1:105 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1405
Practice Address - Country:US
Practice Address - Phone:719-260-0216
Practice Address - Fax:719-227-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO82101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty