Provider Demographics
NPI:1790900728
Name:WESTWOOD DENTAL GROUP PC
Entity Type:Organization
Organization Name:WESTWOOD DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRABIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-988-6110
Mailing Address - Street 1:3190 S WADSWORTH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4899
Mailing Address - Country:US
Mailing Address - Phone:303-988-6110
Mailing Address - Fax:303-988-8307
Practice Address - Street 1:3190 S WADSWORTH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-4899
Practice Address - Country:US
Practice Address - Phone:303-988-6110
Practice Address - Fax:303-988-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33161223E0200X
CO80781223G0001X
CO65961223G0001X
CO31051223G0001X
CO65651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty