Provider Demographics
NPI:1568835874
Name:ORAL HEALTH IMPACT PROJECT COLORADO
Entity Type:Organization
Organization Name:ORAL HEALTH IMPACT PROJECT COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BICKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-916-6447
Mailing Address - Street 1:6097 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-1810
Mailing Address - Country:US
Mailing Address - Phone:866-916-6447
Mailing Address - Fax:267-927-5007
Practice Address - Street 1:6097 EASTON RD
Practice Address - Street 2:
Practice Address - City:PIPERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18947-1810
Practice Address - Country:US
Practice Address - Phone:866-916-6447
Practice Address - Fax:267-927-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty