Provider Demographics
NPI:1710575451
Name:EXPERIENCE DENTAL 2 PLLC
Entity Type:Organization
Organization Name:EXPERIENCE DENTAL 2 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTDORFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-706-0765
Mailing Address - Street 1:9101 PEARL ST STE 217
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4353
Mailing Address - Country:US
Mailing Address - Phone:303-576-9016
Mailing Address - Fax:
Practice Address - Street 1:9101 PEARL ST STE 217
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4353
Practice Address - Country:US
Practice Address - Phone:303-576-9016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental