Provider Demographics
NPI:1922175793
Name:TAFOLLA AND RIKLI FAMILY DENTISTRY
Entity Type:Organization
Organization Name:TAFOLLA AND RIKLI FAMILY DENTISTRY
Other - Org Name:PEAK VISTA FAMILY DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:TAFOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-598-6680
Mailing Address - Street 1:5478 TOMAH DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918
Mailing Address - Country:US
Mailing Address - Phone:719-598-6680
Mailing Address - Fax:719-598-4037
Practice Address - Street 1:5478 TOMAH DRIVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1928
Practice Address - Country:US
Practice Address - Phone:719-598-6680
Practice Address - Fax:719-598-4037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty