Provider Demographics
NPI:1083729636
Name:EXCELLENCE IN DENTISTRY
Entity Type:Organization
Organization Name:EXCELLENCE IN DENTISTRY
Other - Org Name:LOUISVILLE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:W
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-665-7505
Mailing Address - Street 1:1760 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027
Mailing Address - Country:US
Mailing Address - Phone:303-665-7505
Mailing Address - Fax:303-664-9941
Practice Address - Street 1:1760 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:303-665-7505
Practice Address - Fax:303-664-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104857122300000X
CO63122300000X
CO9319122300000X
CO10514122300000X
CO10679122300000X
CO10691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty