Provider Demographics
NPI:1417978453
Name:COLORADO ENDODONTIC SPECIALISTS, INC
Entity Type:Organization
Organization Name:COLORADO ENDODONTIC SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACARAEG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:303-795-9699
Mailing Address - Street 1:2 W DRY CREEK CIR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8068
Mailing Address - Country:US
Mailing Address - Phone:303-795-9699
Mailing Address - Fax:
Practice Address - Street 1:2 W DRY CREEK CIR
Practice Address - Street 2:SUITE 170
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8068
Practice Address - Country:US
Practice Address - Phone:303-795-9699
Practice Address - Fax:303-795-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty