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EDEN DENTAL PUEBLO PC NPI 1154970366


NPI Information

NPI: 1154970366
Provider Name: EDEN DENTAL PUEBLO PC

Doing Business As: IMPLANT & PERIODONTIC SPECIALISTS OF PUEBLO

Classification: Dentist - 1223P0300X
Entity Type: Organization

Specialization: Periodontics

Address:
2041 PEPPER LN
PUEBLO, CO
ZIP 81005
Phone: (719) 696-9009
Get Directions

EDEN DENTAL PUEBLO PC is a periodontics dentist in Pueblo, CO. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. EDEN DENTAL PUEBLO PC NPI is 1154970366. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Implant & Periodontic Specialists Of Pueblo.

The provider's business location address is:

2041 PEPPER LN
PUEBLO, CO
ZIP 81005-276
Phone: (719) 696-9009

The provider's authorized official is Michael Robert Herrera .
The authorized official title is Business Manager and has the following contact phone number (760) 978-8527.

The enumeration date for this NPI number is 9/10/2019 and was last updated on 11/12/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral PracticeNo
21223P0300XDentistPeriodonticsYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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