Provider Demographics
NPI:1598940785
Name:TRI LAKES DENTAL
Entity Type:Organization
Organization Name:TRI LAKES DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAROM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMOREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-488-5981
Mailing Address - Street 1:1864 WOODMOOR DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9095
Mailing Address - Country:US
Mailing Address - Phone:719-488-5981
Mailing Address - Fax:
Practice Address - Street 1:1864 WOODMOOR DR
Practice Address - Street 2:SUITE #101
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9095
Practice Address - Country:US
Practice Address - Phone:719-488-5981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO93351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty