PUEBLO ENDODONTIC ASSO LLC (NPI# 1609096999) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609096999 |
| Entity Type | Organization |
| Organization Name | PUEBLO ENDODONTIC ASSO LLC |
| Practice Address |
41 Montebello Suite 206 Pueblo CO 81001 |
| Mailing Address |
Po Box 9660 Pueblo CO 81008-9409 |
| Practice Telephone | 7195448900 |
| Practice Fax Number | 7195450700 |
| Mailing Telephone | 7195448900 |
| Mailing Fax Number | 7195450700 |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. REGINALD R WESTPHAL (PRESIDENT) |
| Authorized Official Telephone | 7195448900 |
| Authorized Official Credential | DDS MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
100988 | CO | Dental Providers |
| Street Address |
41 MONTEBELLO SUITE 206 |
| City | PUEBLO |
| State | CO |
| Zip Code | 81001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588222863 | 1111 Bonforte Opco LLC | Respite Care | 855 Hunter Dr., Pueblo, CO 81001 | 2019-06-03 |
| 1992276026 | Andrew Benjamin Basham | Counselor | 1003 Rupple St Pueblo Co 81001, 606, Pueblo, CO 81001 | 2018-12-16 |
| 1316456981 | Amy R Leibli | Nurse Practitioner | 1080 Chinook Lane, Pueblo, CO 81001 | 2017-09-26 |
| 1457781262 | Ron Concialdi | Dentist | 2037 Jerry Murphy Rd., Pueblo, CO 81001 | 2013-11-14 |
| 1609146950 | Natasha Liette Mondragon | Registered Nurse | 1302 E. 5th, Pueblo, CO 81001 | 2012-01-04 |
| 1023303575 | Malinda Lee Davis | Registered Nurse | 1302 E 5th, Pueblo, CO 81001 | 2011-06-13 |
| 1679876429 | Michael Edward Leyba | Substance Abuse Rehabilitation Facility | 4 Montebello Rd., Pueblo, CO 81001 | 2010-12-17 |
| 1609008796 | Laura Ann Mcmahon | Nurse Practitioner | 4020 Jerry Murphy Rd/, Pueblo, CO 81001 | 2009-08-21 |
| 1730380882 | Corrine Stella Tafoya | Counselor | 44 Calhoun Rd, Pueblo, CO 81001 | 2007-05-29 |
| 1518171008 | George Henry Beck | Dentist | 1700 N Salem Ave, Suite A, Pueblo, CO 81001 | 2007-05-10 |
| Find all providers in zip 81001 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598050247 | Dennis Ray Gimlin | Dentist | 3238 Shalimar Ter, Pueblo, CO 81008-1511 | 2011-06-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093329047 | Front Range Endodontics, Pllc | Dentist | 2116 Hollow Brook Dr Ste 200, Colorado Springs, CO 80918-1790 | 2020-09-06 |
| 1205448107 | Avos Dental Specialists, Pllc | Dentist | 14769 W 87th Pkwy, Arvada, CO 80005-1454 | 2020-08-20 |
| 1003433251 | Ridgegate Endodontics, Pllc | Dentist | 10107 Ridgegate Pkwy # G020, Lone Tree, CO 80124-5637 | 2020-07-02 |
| 1518511146 | Colorado Dental Specialist Practice, LLC | Dentist | 18121 E Hampden Ave Unit E, Aurora, CO 80013-3591 | 2019-07-31 |
| 1447803382 | Jj Elevation, Pllc | Dentist | 10012 Coyote Song Ter, Colorado Springs, CO 80924-4504 | 2019-07-19 |
| 1992363444 | Ccdi Parker Pdc Pllc | Dentist | 10841 Crossroads Dr Ste 9, Parker, CO 80134-9090 | 2019-05-30 |
| 1134786403 | Safer,carr and Sachs, Dds,pc | Dentist | 155 Cook St Ste 301, Denver, CO 80206-5317 | 2019-05-22 |
| 1013573815 | Ccdi Denver Pdc Pllc | Dentist | 1573 S Broadway, Denver, CO 80210-2607 | 2019-05-16 |
| 1992279384 | Jared Smith, Professional LLC | Dentist | 17 County Road 68, Bailey, CO 80421 | 2019-01-18 |
| 1972000933 | Rocky Mountain Root Canal Specialist, Pllc | Dentist | 13762 Colorado Blvd Unit 154, Thornton, CO 80602-6919 | 2018-04-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.