Provider Demographics
NPI:1043612138
Name:CASTLE PINES, DENTAL PROFESSIONAL, LLC
Entity Type:Organization
Organization Name:CASTLE PINES, DENTAL PROFESSIONAL, LLC
Other - Org Name:CASTLE PINES DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANHOF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:720-457-1111
Mailing Address - Street 1:562 E CASTLE PINES PKWY
Mailing Address - Street 2:SUITE C-8
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-4609
Mailing Address - Country:US
Mailing Address - Phone:720-457-1111
Mailing Address - Fax:888-790-7062
Practice Address - Street 1:562 E CASTLE PINES PKWY
Practice Address - Street 2:SUITE C-8
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-4609
Practice Address - Country:US
Practice Address - Phone:720-457-1111
Practice Address - Fax:888-790-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2020001223E0200X, 1223G0001X, 1223P0300X, 1223S0112X
CO202001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO202000OtherSTATE OF COLORADO