Provider Demographics
NPI:1720592157
Name:LIL TEETH DENTISTRY PLLC
Entity Type:Organization
Organization Name:LIL TEETH DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-307-9999
Mailing Address - Street 1:3464 N. SALIDA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011
Mailing Address - Country:US
Mailing Address - Phone:303-307-9999
Mailing Address - Fax:303-307-9992
Practice Address - Street 1:3464 N SALIDA CT
Practice Address - Street 2:SUITE A
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-5031
Practice Address - Country:US
Practice Address - Phone:303-307-9999
Practice Address - Fax:303-307-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty