Provider Demographics
NPI:1902023799
Name:COLORADO SPRINGS DENTAL SERVICES PC
Entity Type:Organization
Organization Name:COLORADO SPRINGS DENTAL SERVICES PC
Other - Org Name:COLORADO SPRINGS RESTORATIVE DENTISTRY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:CULLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-591-2004
Mailing Address - Street 1:685 CITADEL DR E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5314
Mailing Address - Country:US
Mailing Address - Phone:719-591-2004
Mailing Address - Fax:719-623-0305
Practice Address - Street 1:685 CITADEL DR E
Practice Address - Street 2:SUITE 300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5314
Practice Address - Country:US
Practice Address - Phone:719-591-2004
Practice Address - Fax:719-623-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty