Provider Demographics
NPI:1821042896
Name:LURCOTT, GREGG LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:LAWRENCE
Last Name:LURCOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GOOSEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-4126
Mailing Address - Country:US
Mailing Address - Phone:303-744-1369
Mailing Address - Fax:303-744-9879
Practice Address - Street 1:400 S COLORADO BLVD
Practice Address - Street 2:SUITE 450
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1253
Practice Address - Country:US
Practice Address - Phone:303-744-1369
Practice Address - Fax:303-744-9879
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010176461223S0112X
CO98351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI970E07680OtherBLUE CROSS PIN
MI970E07680OtherBLUE CROSS PIN
MI0E07680009Medicare ID - Type Unspecified