Provider Demographics
NPI:1558651042
Name:LITTLETON DENTAL
Entity Type:Organization
Organization Name:LITTLETON DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-933-8880
Mailing Address - Street 1:7735 W LONG DR
Mailing Address - Street 2:UNIT 9
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-1266
Mailing Address - Country:US
Mailing Address - Phone:303-932-6847
Mailing Address - Fax:303-932-6847
Practice Address - Street 1:7735 W LONG DR
Practice Address - Street 2:UNIT 9
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123
Practice Address - Country:US
Practice Address - Phone:303-933-8880
Practice Address - Fax:303-932-6847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95981223G0001X
CO100951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty