Provider Demographics
NPI:1073042370
Name:THERESA SHAVER ORTHODONTICS
Entity Type:Organization
Organization Name:THERESA SHAVER ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHDONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-751-1313
Mailing Address - Street 1:5001 S PARKER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1183
Mailing Address - Country:US
Mailing Address - Phone:303-751-1313
Mailing Address - Fax:303-750-3070
Practice Address - Street 1:5001 S PARKER RD STE 201
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1183
Practice Address - Country:US
Practice Address - Phone:303-751-1313
Practice Address - Fax:303-750-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17452252Medicaid