Provider Demographics
NPI:1508197294
Name:MOUNTAIN TOP PERIODONTICS AND IMPLANTS
Entity Type:Organization
Organization Name:MOUNTAIN TOP PERIODONTICS AND IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEITNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-740-0080
Mailing Address - Street 1:8000 E PRENTICE AVE
Mailing Address - Street 2:#D-7
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2744
Mailing Address - Country:US
Mailing Address - Phone:303-740-0080
Mailing Address - Fax:303-740-7481
Practice Address - Street 1:8000 E PRENTICE AVE
Practice Address - Street 2:#D-7
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2744
Practice Address - Country:US
Practice Address - Phone:303-740-0080
Practice Address - Fax:303-740-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80941223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty