Provider Demographics
NPI:1619163219
Name:ARISTIDES A TSIKOUDAKIS DMD LLC
Entity Type:Organization
Organization Name:ARISTIDES A TSIKOUDAKIS DMD LLC
Other - Org Name:FOOTHILLS PROSTHETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARISTIDES
Authorized Official - Middle Name:A
Authorized Official - Last Name:TSIKOUDAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-984-9200
Mailing Address - Street 1:255 UNION BLVD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1810
Mailing Address - Country:US
Mailing Address - Phone:303-984-9200
Mailing Address - Fax:303-984-5646
Practice Address - Street 1:255 UNION BLVD
Practice Address - Street 2:SUITE 440
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1810
Practice Address - Country:US
Practice Address - Phone:303-984-9200
Practice Address - Fax:303-984-5646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8927261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental