Provider Demographics
NPI:1609447291
Name:GREGG LURCOTT, DDS, PLLC
Entity Type:Organization
Organization Name:GREGG LURCOTT, DDS, PLLC
Other - Org Name:COLORADO ORAL SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LURCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-744-1369
Mailing Address - Street 1:400 S COLORADO BLVD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246
Mailing Address - Country:US
Mailing Address - Phone:303-744-1369
Mailing Address - Fax:303-744-9879
Practice Address - Street 1:17167 EAST CEDAR GULCH PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:303-699-0351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREG LUCROTT DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-06
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35281278Medicaid