Provider Demographics
NPI:1598103384
Name:SVC DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:SVC DENTAL GROUP, LLC
Other - Org Name:TOOTHZONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BAILY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-223-8687
Mailing Address - Street 1:1220 OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7302
Mailing Address - Country:US
Mailing Address - Phone:970-223-8687
Mailing Address - Fax:970-225-1574
Practice Address - Street 1:1220 OAK PARK DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7302
Practice Address - Country:US
Practice Address - Phone:970-223-8687
Practice Address - Fax:970-225-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN 002019661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty