Provider Demographics
NPI:1467572396
Name:PERFECT TEETH - EAST ILIFF P.C.
Entity Type:Organization
Organization Name:PERFECT TEETH - EAST ILIFF P.C.
Other - Org Name:PERFECT TEETH - EAST ILIFF P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBUCKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-285-6098
Mailing Address - Street 1:17200 E ILIFF AVE
Mailing Address - Street 2:STE. A7
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-5833
Mailing Address - Country:US
Mailing Address - Phone:303-337-0464
Mailing Address - Fax:303-337-8703
Practice Address - Street 1:17200 E ILIFF AVE
Practice Address - Street 2:STE. A7
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-5833
Practice Address - Country:US
Practice Address - Phone:303-337-0464
Practice Address - Fax:303-337-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty