Provider Demographics
NPI:1104181940
Name:DENVER PERIODONTICS AND IMPLANT DENTISTRY
Entity Type:Organization
Organization Name:DENVER PERIODONTICS AND IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:303-721-1173
Mailing Address - Street 1:7384 S ALTON WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2369
Mailing Address - Country:US
Mailing Address - Phone:303-721-1173
Mailing Address - Fax:303-721-1179
Practice Address - Street 1:7384 S ALTON WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2369
Practice Address - Country:US
Practice Address - Phone:303-721-1173
Practice Address - Fax:303-721-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty