Provider Demographics
NPI:1902458862
Name:DOPPEL, DEZI GRACE
Entity Type:Individual
Prefix:
First Name:DEZI
Middle Name:GRACE
Last Name:DOPPEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8580 SCARBOROUGH DR STE 240
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7584
Mailing Address - Country:US
Mailing Address - Phone:719-590-1500
Mailing Address - Fax:719-590-9379
Practice Address - Street 1:8580 SCARBOROUGH DR STE 240
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7584
Practice Address - Country:US
Practice Address - Phone:719-590-1500
Practice Address - Fax:719-590-9379
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA.0001862126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Single Specialty