Provider Demographics
NPI:1942673397
Name:COLORADO SPRINGS DENTAL SERVICES, PC
Entity Type:Organization
Organization Name:COLORADO SPRINGS DENTAL SERVICES, PC
Other - Org Name:LOWELL MOBILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-591-2004
Mailing Address - Street 1:251 E FOUNTAIN BLVD UNIT 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4160
Mailing Address - Country:US
Mailing Address - Phone:719-591-2004
Mailing Address - Fax:
Practice Address - Street 1:251 E FOUNTAIN BLVD UNIT 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4160
Practice Address - Country:US
Practice Address - Phone:719-591-2004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73481223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty