Provider Demographics
NPI:1679740278
Name:LAKEWOOD FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:LAKEWOOD FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:ROLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-237-4831
Mailing Address - Street 1:7700 W 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-4110
Mailing Address - Country:US
Mailing Address - Phone:303-237-4831
Mailing Address - Fax:303-237-2214
Practice Address - Street 1:7700 W 14TH AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-4110
Practice Address - Country:US
Practice Address - Phone:303-237-4831
Practice Address - Fax:303-237-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty