Medicaid Dental Home
LBN: Medicaid Dental Home
Medicaid Dental Home is an health care organization with primary practice located at 2125 E La Salle St , Colorado Springs CO 80909-2274. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / Dental Public Health, Dental Providers / Dental Hygienist. Dental Providers / Dental Public Health is the primary health care specialty.
Medicaid Dental Home can be contacted via phone (719) 310-3315, or through Vacha, Michelle via phone (719) 338-2195.
Contact Information
Primary practice address
2125 E La Salle St
Colorado Springs CO 80909-2274
Phone: (719) 310-3315
Fax:
Website:
Authorized official contact:
Name: Vacha, Michelle Registered Dental Hygienist (RDH)
Phone: (719) 338-2195
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dental Public Health | 1223D0001X | 8109 | Colorado |
| Dental Providers / Dental Hygienist | 124Q00000X | 903783 | Colorado |
Profile Details
| NPI number | 1336570167 |
|---|---|
| LBN Legal business name | Medicaid Dental Home |
| DBA Doing business as | |
| Authorized official | Vacha, Michelle Registered Dental Hygienist (RDH) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Dec 4th, 2013 |
| Last updated | Dec 4th, 2013 - about 11 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336570167 | NPPES |
| Colorado | MEDICAID | 84887761 |
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