Provider Demographics
NPI:1164661013
Name:ARVADA MODERN DENTISTRY, LLP
Entity Type:Organization
Organization Name:ARVADA MODERN DENTISTRY, LLP
Other - Org Name:ARVADA MODERN DENTISTRY AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-456-4095
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:303-484-2596
Practice Address - Street 1:14807 W 64TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-0104
Practice Address - Country:US
Practice Address - Phone:303-456-4095
Practice Address - Fax:303-484-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty