Provider Demographics
NPI:1467597021
Name:COLORADO DHCA GREELEY, PLLC
Entity Type:Organization
Organization Name:COLORADO DHCA GREELEY, PLLC
Other - Org Name:DENTAL HEALTH OF GREELEY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-353-4329
Mailing Address - Street 1:1600 23RD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6071
Mailing Address - Country:US
Mailing Address - Phone:970-353-4329
Mailing Address - Fax:970-353-0526
Practice Address - Street 1:1600 23RD AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6071
Practice Address - Country:US
Practice Address - Phone:970-353-4329
Practice Address - Fax:970-353-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty