Provider Demographics
NPI:1174344956
Name:STATE BOARD FOR COMMUNITY COLLEGES AND OCCUPATIONAL EDUCATION
Entity type:Organization
Organization Name:STATE BOARD FOR COMMUNITY COLLEGES AND OCCUPATIONAL EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EWA
Authorized Official - Middle Name:
Authorized Official - Last Name:POSORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-502-3437
Mailing Address - Street 1:11125 CROSS PEAK VW
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3420
Mailing Address - Country:US
Mailing Address - Phone:719-502-3437
Mailing Address - Fax:
Practice Address - Street 1:11125 CROSS PEAK VW
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3420
Practice Address - Country:US
Practice Address - Phone:719-502-3437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIKES PEAK STATE COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental