Provider Demographics
NPI:1619976990
Name:COLORADO KIDS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:COLORADO KIDS PEDIATRIC DENTISTRY
Other - Org Name:DRS. FOX, WAGUESPACK & NORWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MEHELICH
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-791-4400
Mailing Address - Street 1:9358 DORCHESTER ST.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129
Mailing Address - Country:US
Mailing Address - Phone:303-791-4400
Mailing Address - Fax:303-471-1206
Practice Address - Street 1:9358 DORCHESTER ST.
Practice Address - Street 2:SUITE 106
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129
Practice Address - Country:US
Practice Address - Phone:303-225-4715
Practice Address - Fax:303-688-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6741223P0221X
CO83301223P0221X
CO002019801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1427078435OtherLISA MEHELICH FOX, DDS NPI
CO1215048806OtherKATHLEEN E. WAGUESPACK, DMD, NPI
CO1427078435OtherLISA MEHELICH FOX, DDS NPI