Provider Demographics
NPI:1821316217
Name:LI'L TEETH DENTISTRY
Entity Type:Organization
Organization Name:LI'L TEETH DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:V
Authorized Official - Last Name:ROACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-307-9999
Mailing Address - Street 1:3471 N SALIDA CT UNIT 40
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-5020
Mailing Address - Country:US
Mailing Address - Phone:303-307-9999
Mailing Address - Fax:303-307-9992
Practice Address - Street 1:3471 N SALIDA CT UNIT 40
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-5020
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:2010-05-10
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1285897751OtherINDIVIDUAL NPI