Provider Demographics
NPI:1164936035
Name:D SCOTT TOPHAM DDS PROFESSIONAL LLC
Entity Type:Organization
Organization Name:D SCOTT TOPHAM DDS PROFESSIONAL LLC
Other - Org Name:TOPHAM DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:TOPHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-772-2611
Mailing Address - Street 1:1055 17TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2647
Mailing Address - Country:US
Mailing Address - Phone:303-772-2611
Mailing Address - Fax:
Practice Address - Street 1:1055 17TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2647
Practice Address - Country:US
Practice Address - Phone:303-772-2611
Practice Address - Fax:303-772-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10254261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992911762OtherINDIVIDUAL NPI TYPE 1