Provider Demographics
NPI:1558484691
Name:ANDANTE ENDODONTIC SPECIALISTS, PROF. LLC
Entity Type:Organization
Organization Name:ANDANTE ENDODONTIC SPECIALISTS, PROF. LLC
Other - Org Name:ANDANTE ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDA
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:DEGERNESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MBA
Authorized Official - Phone:303-726-6565
Mailing Address - Street 1:8340 SANGRE DE CRISTO RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4243
Mailing Address - Country:US
Mailing Address - Phone:303-948-4884
Mailing Address - Fax:720-922-7734
Practice Address - Street 1:8340 SANGRE DE CRISTO RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4248
Practice Address - Country:US
Practice Address - Phone:303-948-4884
Practice Address - Fax:720-922-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN000000005149261QD0000X
MND9660261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental