Provider Demographics
NPI:1528505682
Name:COLORADO SPRINGS DENTAL CARE
Entity type:Organization
Organization Name:COLORADO SPRINGS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEFCIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-400-4560
Mailing Address - Street 1:5731 SILVERSTONE TERRACE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3552
Mailing Address - Country:US
Mailing Address - Phone:719-334-5693
Mailing Address - Fax:719-434-1084
Practice Address - Street 1:5731 SILVERSTONE TER
Practice Address - Street 2:SUITE 270
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3575
Practice Address - Country:US
Practice Address - Phone:719-334-5693
Practice Address - Fax:719-434-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty