Provider Demographics
NPI:1407494321
Name:LITTLE ROCKIES KIDS DENTAL. LLC
Entity Type:Organization
Organization Name:LITTLE ROCKIES KIDS DENTAL. LLC
Other - Org Name:LITTLE ROCKIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:OHMART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MC,PC
Authorized Official - Phone:303-881-1263
Mailing Address - Street 1:10146 W SAN JUAN WAY UNIT 230
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6326
Mailing Address - Country:US
Mailing Address - Phone:303-881-1263
Mailing Address - Fax:
Practice Address - Street 1:10371 PARKGLENN WAY STE 260
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3872
Practice Address - Country:US
Practice Address - Phone:720-638-6114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty