Provider Demographics
NPI:1790299279
Name:NORTHPARK DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:NORTHPARK DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-466-2300
Mailing Address - Street 1:10359 FEDERAL BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-7453
Mailing Address - Country:US
Mailing Address - Phone:303-466-2300
Mailing Address - Fax:303-466-8666
Practice Address - Street 1:10359 FEDERAL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80260-7453
Practice Address - Country:US
Practice Address - Phone:303-466-2300
Practice Address - Fax:303-466-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty