Provider Demographics
NPI:1003227794
Name:TOTAL ORTHODONTICS PROFESSIONAL LLP
Entity Type:Organization
Organization Name:TOTAL ORTHODONTICS PROFESSIONAL LLP
Other - Org Name:TOTAL ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:THEROUX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:303-779-0565
Mailing Address - Street 1:10450 PARK MEADOWS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5530
Mailing Address - Country:US
Mailing Address - Phone:303-779-0565
Mailing Address - Fax:303-804-5394
Practice Address - Street 1:10450 PARK MEADOWS DR STE 300
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5530
Practice Address - Country:US
Practice Address - Phone:303-779-0565
Practice Address - Fax:303-804-5394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO74951223X0400X
CO000104171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty