Provider Demographics
NPI:1154675098
Name:DENTAL ASSOCIATES OF WOODLAND PARK, LLC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF WOODLAND PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:HELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-687-2000
Mailing Address - Street 1:150 MORNING SUN DR
Mailing Address - Street 2:200 WEST
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-9160
Mailing Address - Country:US
Mailing Address - Phone:719-687-2000
Mailing Address - Fax:719-687-9213
Practice Address - Street 1:150 MORNING SUN DR
Practice Address - Street 2:200 WEST
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-9160
Practice Address - Country:US
Practice Address - Phone:719-687-2000
Practice Address - Fax:719-687-9213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3577305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization