Provider Demographics
NPI:1174818827
Name:HIGH COUNTRY DENTAL
Entity Type:Organization
Organization Name:HIGH COUNTRY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:CASEY
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-693-5600
Mailing Address - Street 1:20250 E SMOKY HILL RD
Mailing Address - Street 2:UNIT #3
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3118
Mailing Address - Country:US
Mailing Address - Phone:303-693-5600
Mailing Address - Fax:303-693-8170
Practice Address - Street 1:20250 E SMOKY HILL RD
Practice Address - Street 2:UNIT #3
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3118
Practice Address - Country:US
Practice Address - Phone:303-693-5600
Practice Address - Fax:303-693-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty