Provider Demographics
NPI:1336512540
Name:CHEYENNE MOUNTAIN MODERN DENTISTRY, LLP
Entity Type:Organization
Organization Name:CHEYENNE MOUNTAIN MODERN DENTISTRY, LLP
Other - Org Name:CHEYENNE MOUNTAIN MODERN DENTISTRY AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PFEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-800-0399
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:4451 VENETUCCI BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80906
Practice Address - Country:US
Practice Address - Phone:719-800-0399
Practice Address - Fax:719-359-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty