Provider Demographics
NPI:1225275282
Name:CHILDREN'S DENTAL CENTER
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-421-5437
Mailing Address - Street 1:7975 ALLISON WAY
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-4428
Mailing Address - Country:US
Mailing Address - Phone:303-421-5437
Mailing Address - Fax:303-422-5300
Practice Address - Street 1:7975 ALLISON WAY
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-4428
Practice Address - Country:US
Practice Address - Phone:303-421-5437
Practice Address - Fax:303-422-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84661223P0221X
CO63651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty