Provider Demographics
NPI:1376543850
Name:CHILDREN'S DENTAL HEALTH CENTER, P.C.
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL HEALTH CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-751-6511
Mailing Address - Street 1:2295 S CHAMBERS RD
Mailing Address - Street 2:#E
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4544
Mailing Address - Country:US
Mailing Address - Phone:303-751-6511
Mailing Address - Fax:303-283-5944
Practice Address - Street 1:2295 S CHAMBERS RD
Practice Address - Street 2:#E
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4544
Practice Address - Country:US
Practice Address - Phone:303-751-6511
Practice Address - Fax:303-283-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41537815Medicaid