Provider Demographics
NPI:1629662770
Name:ALL KIDS DENTAL PEDIATRICS AND ORTHODONTICS
Entity Type:Organization
Organization Name:ALL KIDS DENTAL PEDIATRICS AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-928-9500
Mailing Address - Street 1:2624 GRAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4676
Mailing Address - Country:US
Mailing Address - Phone:970-928-9500
Mailing Address - Fax:
Practice Address - Street 1:204 W HYMAN AVE
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1753
Practice Address - Country:US
Practice Address - Phone:970-928-9500
Practice Address - Fax:970-928-7467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89222385Medicaid