Provider Demographics
NPI:1336294388
Name:ALTURA PERIODONTICS
Entity Type:Organization
Organization Name:ALTURA PERIODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POMERANZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-609-0990
Mailing Address - Street 1:3690 S YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1826
Mailing Address - Country:US
Mailing Address - Phone:303-695-0990
Mailing Address - Fax:303-695-6915
Practice Address - Street 1:3690 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1827
Practice Address - Country:US
Practice Address - Phone:303-695-0990
Practice Address - Fax:303-695-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1049551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty