Provider Demographics
NPI:1699438861
Name:CM DDS, PLLC
Entity type:Organization
Organization Name:CM DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADJAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-565-7388
Mailing Address - Street 1:10917 HIDDEN PRAIRIE PKWY
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-7263
Mailing Address - Country:US
Mailing Address - Phone:719-565-7388
Mailing Address - Fax:
Practice Address - Street 1:721 N CASCADE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3211
Practice Address - Country:US
Practice Address - Phone:719-565-7388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CM DDS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental