Provider Demographics
NPI:1427771203
Name:DENTAL SPECIALISTS OF SOUTHERN COLORADO, PC
Entity type:Organization
Organization Name:DENTAL SPECIALISTS OF SOUTHERN COLORADO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REECE
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-569-5959
Mailing Address - Street 1:332 S ORCHARD SPRINGS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-6154
Mailing Address - Country:US
Mailing Address - Phone:719-569-5959
Mailing Address - Fax:719-300-5259
Practice Address - Street 1:332 S ORCHARD SPRINGS DR STE 110
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-6154
Practice Address - Country:US
Practice Address - Phone:719-569-5959
Practice Address - Fax:719-300-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty