Provider Demographics
NPI:1558575167
Name:PLATTE RIVER FAMILY DENTAL P C
Entity Type:Organization
Organization Name:PLATTE RIVER FAMILY DENTAL P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PASCO
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCARPELLA
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:303-659-8200
Mailing Address - Street 1:965 PLATTE RIVER BLVD UNIT E
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4353
Mailing Address - Country:US
Mailing Address - Phone:303-659-8200
Mailing Address - Fax:720-685-9113
Practice Address - Street 1:965 PLATTE RIVER BLVD UNIT E
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4353
Practice Address - Country:US
Practice Address - Phone:303-659-8200
Practice Address - Fax:720-685-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty