Provider Demographics
NPI:1518260413
Name:CHERRY CREEK DENTAL PARTNERS
Entity Type:Organization
Organization Name:CHERRY CREEK DENTAL PARTNERS
Other - Org Name:COMFORT DENTAL CHERRY CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-321-2233
Mailing Address - Street 1:201 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4657
Mailing Address - Country:US
Mailing Address - Phone:303-321-2233
Mailing Address - Fax:303-321-0967
Practice Address - Street 1:201 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4657
Practice Address - Country:US
Practice Address - Phone:303-321-2233
Practice Address - Fax:303-321-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86001223E0200X
CO74711223G0001X
CO96871223G0001X
CO75261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty