Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Medicaid Dental Home

Organization Public Health Dentistry · NPI 1336570167

Medicaid Dental Home is a Public Health Dentistry in Colorado Springs, Colorado. Licensed in Colorado. Registered with an NPI since 2013.

Licensed in
CO
In the registry since
2013
Specialties on file
2

Practice location Address checks out

2125 E La Salle St
Colorado Springs, CO 80909-2274
Phone: (719) 310-3315
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Public Health Dentistry (primary) Taxonomy 1223D0001X · Licence 8109 (CO)
Dental Hygienist Taxonomy 124Q00000X · Licence 903783 (CO)

Record details

NPI number1336570167
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Michelle Vacha — Executive Director · (719) 338-2195
NPI enumeratedDecember 4, 2013
Last updated in NPPESDecember 4, 2013
Mailing address2604 Flintridge Dr, Colorado Springs, CO 80918-4408

Other providers in Colorado Springs