1700020104 NPI number — PROMINENT POINT DENTAL GROUP AND ORTHODONTICS, LLP

Table of content: SUZANNA AVERY ARNP, CNM (NPI 1972061174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700020104 NPI number — PROMINENT POINT DENTAL GROUP AND ORTHODONTICS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROMINENT POINT DENTAL GROUP AND ORTHODONTICS, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700020104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 920050
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75392-0050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-368-2077
Provider Business Mailing Address Fax Number:
714-368-2092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9625 PROMINENT POINT
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-495-5748
Provider Business Practice Location Address Fax Number:
719-785-5716
Provider Enumeration Date:
04/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
COLLETTE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
719-495-5748

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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