Provider Demographics
NPI:1396033684
Name:DENTAL LIFELINE NETWORK COLORADO
Entity Type:Organization
Organization Name:DENTAL LIFELINE NETWORK COLORADO
Other - Org Name:COLORADO FOUNDATION OF DENTISTRY FOR THE HANDICAPPED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT AFFILIATE OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-287-6184
Mailing Address - Street 1:1800 15TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-6100
Mailing Address - Country:US
Mailing Address - Phone:303-534-5360
Mailing Address - Fax:303-534-5290
Practice Address - Street 1:1800 15TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-6100
Practice Address - Country:US
Practice Address - Phone:303-534-5360
Practice Address - Fax:303-534-5290
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL LIFELINE NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable