Provider Demographics
NPI:1407947716
Name:THORNTON YOUTH DENTISTRY, PC
Entity Type:Organization
Organization Name:THORNTON YOUTH DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-886-0699
Mailing Address - Street 1:550 E. THORNTON PARKWAY
Mailing Address - Street 2:SUITE 240A
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2100
Mailing Address - Country:US
Mailing Address - Phone:303-280-8878
Mailing Address - Fax:303-280-8993
Practice Address - Street 1:550 E. THORNTON PKWY
Practice Address - Street 2:SUITE 240-A
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2100
Practice Address - Country:US
Practice Address - Phone:303-280-8878
Practice Address - Fax:303-280-8993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89105532Medicaid
CO1777419OtherUNITED CONCORDIA