Provider Demographics
NPI:1780839696
Name:CREEKSIDE SMILES OF CHERRY CREEK, PLLC
Entity Type:Organization
Organization Name:CREEKSIDE SMILES OF CHERRY CREEK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARI
Authorized Official - Middle Name:NOREEN
Authorized Official - Last Name:MARCOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-241-4800
Mailing Address - Street 1:155 COOK ST
Mailing Address - Street 2:STE #141
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5325
Mailing Address - Country:US
Mailing Address - Phone:303-329-0505
Mailing Address - Fax:
Practice Address - Street 1:155 COOK ST
Practice Address - Street 2:STE #141
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5325
Practice Address - Country:US
Practice Address - Phone:303-329-0505
Practice Address - Fax:303-329-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty