Provider Demographics
NPI:1013780279
Name:WESTSIDE DENTAL HOLDINGS PLLC
Entity Type:Organization
Organization Name:WESTSIDE DENTAL HOLDINGS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOST DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CHRISTIAN DWYER
Authorized Official - Last Name:COTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-274-3024
Mailing Address - Street 1:6207 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4422
Mailing Address - Country:US
Mailing Address - Phone:970-274-3024
Mailing Address - Fax:
Practice Address - Street 1:1330 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-4023
Practice Address - Country:US
Practice Address - Phone:719-633-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental