Provider Demographics
NPI:1669865457
Name:MARK S. EHRHARDT, DDS, LLC
Entity Type:Organization
Organization Name:MARK S. EHRHARDT, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:EHRHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-659-1825
Mailing Address - Street 1:2700 E BRIDGE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2591
Mailing Address - Country:US
Mailing Address - Phone:303-659-1825
Mailing Address - Fax:303-637-9547
Practice Address - Street 1:2700 E BRIDGE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2591
Practice Address - Country:US
Practice Address - Phone:303-659-1825
Practice Address - Fax:303-637-9547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO64811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty