Provider Demographics
NPI:1114582509
Name:OPEN AND AFFORDABLE DENTAL FIRESTONE
Entity Type:Organization
Organization Name:OPEN AND AFFORDABLE DENTAL FIRESTONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PIPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-755-2709
Mailing Address - Street 1:6640 OWL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5450
Mailing Address - Country:US
Mailing Address - Phone:620-755-2709
Mailing Address - Fax:
Practice Address - Street 1:4275 CITY CENTRE DR UNIT 400
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6678
Practice Address - Country:US
Practice Address - Phone:620-755-2709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty