Provider Demographics
NPI:1366495889
Name:HERITAGE DENTAL PC
Entity Type:Organization
Organization Name:HERITAGE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-770-9901
Mailing Address - Street 1:8290 SO HOLLY
Mailing Address - Street 2:A
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122
Mailing Address - Country:US
Mailing Address - Phone:303-770-9901
Mailing Address - Fax:303-221-0504
Practice Address - Street 1:8200 SO HOLLY
Practice Address - Street 2:GERITAGE DENTAL PC
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122
Practice Address - Country:US
Practice Address - Phone:303-770-9901
Practice Address - Fax:303-221-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72771223G0001X
CO77891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty