Provider Demographics
NPI:1003412131
Name:LTHAWS LLC
Entity Type:Organization
Organization Name:LTHAWS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-688-3800
Mailing Address - Street 1:858 W HAPPY CANYON RD STE 135
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3916
Mailing Address - Country:US
Mailing Address - Phone:303-688-3800
Mailing Address - Fax:303-688-3999
Practice Address - Street 1:858 W HAPPY CANYON RD STE 135
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-3916
Practice Address - Country:US
Practice Address - Phone:303-688-3800
Practice Address - Fax:303-688-3999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTISTRY AT HAPPY CANYON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1251538Medicaid