Provider Demographics
NPI:1528210606
Name:WESTMINSTER DENTAL PC
Entity Type:Organization
Organization Name:WESTMINSTER DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:VAN WAGENEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-426-6662
Mailing Address - Street 1:8300 ALCOTT ST
Mailing Address - Street 2:205
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-4008
Mailing Address - Country:US
Mailing Address - Phone:303-426-6662
Mailing Address - Fax:303-426-1530
Practice Address - Street 1:8300 ALCOTT ST
Practice Address - Street 2:205
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-4008
Practice Address - Country:US
Practice Address - Phone:303-426-6662
Practice Address - Fax:303-426-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty