Provider Demographics
NPI:1003250382
Name:TODD M. JUHLIN D.D.S., P.C.
Entity Type:Organization
Organization Name:TODD M. JUHLIN D.D.S., P.C.
Other - Org Name:RED ROCKS ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:JUHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-430-6112
Mailing Address - Street 1:9200 W CROSS DR
Mailing Address - Street 2:SUITE 603
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2239
Mailing Address - Country:US
Mailing Address - Phone:303-932-7458
Mailing Address - Fax:303-932-7460
Practice Address - Street 1:9200 W CROSS DR
Practice Address - Street 2:SUITE 603
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2239
Practice Address - Country:US
Practice Address - Phone:303-932-7458
Practice Address - Fax:303-932-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10460261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0184226Medicaid
1033134358OtherNPI
1033134358OtherNPI