Provider Demographics
NPI:1477202679
Name:LPDG ROBIOUS ROAD PEDO PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LPDG ROBIOUS ROAD PEDO PROFESSIONAL CORPORATION
Other - Org Name:MIDLOTHIAN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-255-6371
Mailing Address - Street 1:4643 S ULSTER ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2853
Mailing Address - Country:US
Mailing Address - Phone:720-603-4763
Mailing Address - Fax:720-532-8809
Practice Address - Street 1:11601 ROBIOUS RD STE 120
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-5605
Practice Address - Country:US
Practice Address - Phone:804-459-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty