Provider Demographics
NPI:1770998130
Name:FLINTRIDGE DENTAL CENTER PC
Entity type:Organization
Organization Name:FLINTRIDGE DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:UTKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-593-8701
Mailing Address - Street 1:5770 FLINTRIDGE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1882
Mailing Address - Country:US
Mailing Address - Phone:719-593-8701
Mailing Address - Fax:719-593-9258
Practice Address - Street 1:5770 FLINTRIDGE DR STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1882
Practice Address - Country:US
Practice Address - Phone:719-593-8701
Practice Address - Fax:719-593-9258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000087701223G0001X
CO1058361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty