Provider Demographics
NPI:1003223504
Name:WHEAT RIDGE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WHEAT RIDGE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAPIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-423-0584
Mailing Address - Street 1:4331 HARLAN ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5121
Mailing Address - Country:US
Mailing Address - Phone:303-423-0584
Mailing Address - Fax:
Practice Address - Street 1:4331 HARLAN ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5121
Practice Address - Country:US
Practice Address - Phone:303-423-0584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06711122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02067114Medicare PIN