Provider Demographics
NPI:1477122018
Name:PROFESSIONAL DENTAL CARE OF CENTRAL CO IV, PLLC
Entity Type:Organization
Organization Name:PROFESSIONAL DENTAL CARE OF CENTRAL CO IV, PLLC
Other - Org Name:LARKRIDGE FAMILY & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LACOUTURE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-841-0549
Mailing Address - Street 1:10233 S PARKER RD STE 107
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9314
Mailing Address - Country:US
Mailing Address - Phone:303-521-5701
Mailing Address - Fax:
Practice Address - Street 1:3200 VILLAGE VISTA DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2595
Practice Address - Country:US
Practice Address - Phone:303-962-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL DENTAL CARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty