Provider Demographics
NPI:1437651387
Name:MOUNTAINAIRE DENTISTRY
Entity Type:Organization
Organization Name:MOUNTAINAIRE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-872-2400
Mailing Address - Street 1:291 E FLATIRON CIR UNIT D
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8060
Mailing Address - Country:US
Mailing Address - Phone:303-872-2400
Mailing Address - Fax:303-872-2401
Practice Address - Street 1:291 E FLATIRON CIR UNIT D
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8060
Practice Address - Country:US
Practice Address - Phone:303-872-2400
Practice Address - Fax:303-872-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10612261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center