My Local Colorado Dental Practice, LLC
Dentist, General Practice in Windsor, CO. Organization (NPI-2).
NPI number1366096893
StatusActive
Last updated in NPPESAug 1, 2019
Details
- NPI
- 1366096893
- Entity type
- Organization (NPI-2)
- Legal business name
- My Local Colorado Dental Practice, LLC
- Organization subpart
- Yes
- Enumeration date
- Aug 1, 2019
- Last updated
- Aug 1, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- Windsor Family Dentistry (Doing Business As)
Practice location
1160 W Ash StWindsor, CO 80550-4666
Phone 970-686-1186
Mailing address
1160 W Ash StWindsor, CO 80550-4666
Phone 970-686-1186
Authorized official
Michelle Johnson
Credentialing Specialist
5093158338
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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