Provider Demographics
NPI:1699015230
Name:WHEAT RIDGE DENTAL PARTNERS PLLC
Entity Type:Organization
Organization Name:WHEAT RIDGE DENTAL PARTNERS PLLC
Other - Org Name:RISAS DENTAL & BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:BOYLE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-339-4800
Mailing Address - Street 1:3030 NORTH CENTRAL AVENUE, SUITE 1500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:602-427-4066
Mailing Address - Fax:
Practice Address - Street 1:3815 N WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:720-536-0400
Practice Address - Fax:720-536-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COD0081861223G0001X
1223S0112X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty