Provider Demographics
NPI:1326229899
Name:COLORADO LOW INCOME DENTAL
Entity Type:Organization
Organization Name:COLORADO LOW INCOME DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-430-7399
Mailing Address - Street 1:2005 FRANKLIN ST
Mailing Address - Street 2:SUITE 590, BUILDING 2
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5401
Mailing Address - Country:US
Mailing Address - Phone:303-430-7399
Mailing Address - Fax:303-863-5851
Practice Address - Street 1:2005 FRANKLIN ST
Practice Address - Street 2:SUITE 590, BUILDING 2
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5401
Practice Address - Country:US
Practice Address - Phone:303-430-7399
Practice Address - Fax:303-863-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40946090000302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization