Provider Demographics
NPI:1407901754
Name:COLORADO KIDS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:COLORADO KIDS PEDIATRIC DENTISTRY
Other - Org Name:DRS. FOX, WAGUESPACK & NORWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MEHELICH
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-791-4400
Mailing Address - Street 1:9227 E LINCOLN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5504
Mailing Address - Country:US
Mailing Address - Phone:303-225-4715
Mailing Address - Fax:303-688-6012
Practice Address - Street 1:9227 E LINCOLN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5504
Practice Address - Country:US
Practice Address - Phone:303-225-4715
Practice Address - Fax:303-688-6012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO KIDS PEDIATRIC DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-25
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83301223P0221X
CO002019801223P0221X
CO6741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1215048806OtherKATHLEEN E. WAGUESPACK, DMD NPI
CO1427078435OtherLISA MEHELICH FOX, DDS NPI
CO1245250109OtherJAMES REED NORWOOD, DDS NPI