Provider Demographics
NPI:1427263185
Name:ASPEN DENTAL ASSOCIATES, PC
Entity type:Organization
Organization Name:ASPEN DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-473-9222
Mailing Address - Street 1:559 E PIKES PEAK AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3651
Mailing Address - Country:US
Mailing Address - Phone:719-473-9222
Mailing Address - Fax:
Practice Address - Street 1:559 E PIKES PEAK AVE
Practice Address - Street 2:STE 203
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3651
Practice Address - Country:US
Practice Address - Phone:719-473-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105258261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental