Provider Demographics
NPI:1518519883
Name:INDIAN PEAKS DENTAL LLC
Entity Type:Organization
Organization Name:INDIAN PEAKS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARA
Authorized Official - Middle Name:RAEANN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-664-5775
Mailing Address - Street 1:1319 W BASELINE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026
Mailing Address - Country:US
Mailing Address - Phone:303-664-5775
Mailing Address - Fax:303-664-5774
Practice Address - Street 1:1319 W BASELINE RD
Practice Address - Street 2:STE 200
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026
Practice Address - Country:US
Practice Address - Phone:303-664-5775
Practice Address - Fax:303-664-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty