Colorado Dental Specialist Practice, LLC
NPI 1154975787ActiveOrganization· Dentist, Periodontics· Denver, CO
Dentist, Periodontics in Denver, Colorado, registered in NPPES in July 2019, part of Colorado Dental Specialist Practice, LLC. The authorized official on file is Michelle Johnson, Credentialing Specialist.
Overview
| NPI | 1154975787 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Colorado Dental Specialist Practice, LLC |
| NPI issued | Jul 31, 2019 |
| Last updated in NPPES | Jul 31, 2019 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, Periodontics Primary | 1223P0300X | — | — |
| Dentist, Endodontics | 1223E0200X | — | — |
| Dentist, Orthodontics and Dentofacial Orthopedics | 1223X0400X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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