Provider Demographics
NPI:1588848568
Name:ACACIA DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:ACACIA DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOTZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-781-0624
Mailing Address - Street 1:3624 S. PENNSYLVANIA ST.
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113
Mailing Address - Country:US
Mailing Address - Phone:303-781-0624
Mailing Address - Fax:303-781-9551
Practice Address - Street 1:3627 S PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3753
Practice Address - Country:US
Practice Address - Phone:303-781-0624
Practice Address - Fax:303-781-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty