Provider Demographics
NPI:1619365020
Name:PIKES PEAK DENTAL X-RAY, INC
Entity Type:Organization
Organization Name:PIKES PEAK DENTAL X-RAY, INC
Other - Org Name:PIKES PEAK DENTAL X-RAY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-529-7227
Mailing Address - Street 1:6010 ERIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3404
Mailing Address - Country:US
Mailing Address - Phone:949-529-7227
Mailing Address - Fax:888-870-2536
Practice Address - Street 1:6010 ERIN PARK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3404
Practice Address - Country:US
Practice Address - Phone:949-529-7227
Practice Address - Fax:888-870-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology