Provider Demographics
NPI:1477768299
Name:LAYCOCK, STEPHEN W (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:LAYCOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 DARLEY AVE.
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305
Mailing Address - Country:US
Mailing Address - Phone:303-494-1550
Mailing Address - Fax:303-494-1752
Practice Address - Street 1:4150 DARLEY AVE.
Practice Address - Street 2:SUITE 7
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305
Practice Address - Country:US
Practice Address - Phone:303-494-1550
Practice Address - Fax:303-494-1752
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7068122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice