Provider Demographics
NPI:1609357144
Name:BAPTIST ROAD DENTAL
Entity Type:Organization
Organization Name:BAPTIST ROAD DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLADSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-839-2458
Mailing Address - Street 1:1036 BAPTIST ROAD
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132
Mailing Address - Country:US
Mailing Address - Phone:303-653-9660
Mailing Address - Fax:303-663-9466
Practice Address - Street 1:1036 BAPTIST ROAD
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132
Practice Address - Country:US
Practice Address - Phone:303-653-9660
Practice Address - Fax:303-663-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty