Provider Demographics
NPI:1154076800
Name:LONGMONT DENTAL CARE
Entity Type:Organization
Organization Name:LONGMONT DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARKER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FALKENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-776-0633
Mailing Address - Street 1:640 TERRY ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4936
Mailing Address - Country:US
Mailing Address - Phone:303-776-0633
Mailing Address - Fax:
Practice Address - Street 1:640 TERRY ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4936
Practice Address - Country:US
Practice Address - Phone:303-776-0633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental