Provider Demographics
NPI:1487825147
Name:PERFECT TEETH - PACE P.C.
Entity Type:Organization
Organization Name:PERFECT TEETH - PACE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-285-6098
Mailing Address - Street 1:1631 PACE ST
Mailing Address - Street 2:UNITE # B-3
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3054
Mailing Address - Country:US
Mailing Address - Phone:303-684-6524
Mailing Address - Fax:303-684-9295
Practice Address - Street 1:1631 PACE ST
Practice Address - Street 2:UNITE # B-3
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3054
Practice Address - Country:US
Practice Address - Phone:303-684-6524
Practice Address - Fax:303-684-9295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty