Provider Demographics
NPI:1629205141
Name:THE FAMILY DENTIST PARTNERSHIP
Entity Type:Organization
Organization Name:THE FAMILY DENTIST PARTNERSHIP
Other - Org Name:THE FAMILY DENTIST
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SKELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-427-8690
Mailing Address - Street 1:4850 W 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80030-4413
Mailing Address - Country:US
Mailing Address - Phone:303-427-8690
Mailing Address - Fax:303-427-6992
Practice Address - Street 1:4850 W 80TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-4413
Practice Address - Country:US
Practice Address - Phone:303-427-8690
Practice Address - Fax:303-427-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5532122300000X
CO8981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty