Provider Demographics
NPI:1376989343
Name:PERFECT TEETH / CENTERRA P.C.
Entity Type:Organization
Organization Name:PERFECT TEETH / CENTERRA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ARBUCKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-285-6098
Mailing Address - Street 1:1685 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8705
Mailing Address - Country:US
Mailing Address - Phone:970-667-2121
Mailing Address - Fax:970-667-2323
Practice Address - Street 1:1685 ROCKY MOUNTAIN AVE
Practice Address - Street 2:STE 400
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8705
Practice Address - Country:US
Practice Address - Phone:970-667-2121
Practice Address - Fax:970-667-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60971223G0001X
CO105411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty