Provider Demographics
NPI:1043642747
Name:ALPHA DENTAL CARE II PC
Entity Type:Organization
Organization Name:ALPHA DENTAL CARE II PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:THERIOT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-758-4287
Mailing Address - Street 1:1660 S ALBION ST STE 715
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4045
Mailing Address - Country:US
Mailing Address - Phone:303-758-4287
Mailing Address - Fax:303-758-0225
Practice Address - Street 1:1660 S ALBION ST STE 715
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4045
Practice Address - Country:US
Practice Address - Phone:303-758-4287
Practice Address - Fax:303-758-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105385261QD0000X
CO6671261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental