Provider Demographics
NPI:1497025472
Name:BETH L NIELSEN
Entity Type:Organization
Organization Name:BETH L NIELSEN
Other - Org Name:SWEETPEA CHILDREN'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:LEONE
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-841-9009
Mailing Address - Street 1:16830 NORTHGATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5778
Mailing Address - Country:US
Mailing Address - Phone:303-841-9009
Mailing Address - Fax:303-841-3695
Practice Address - Street 1:16830 NORTHGATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5778
Practice Address - Country:US
Practice Address - Phone:303-841-9009
Practice Address - Fax:303-841-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO82781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty