Provider Demographics
NPI:1841419009
Name:CASTLE VALLEY DAENTAL PC
Entity Type:Organization
Organization Name:CASTLE VALLEY DAENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-663-4366
Mailing Address - Street 1:610 EAST 5TH ST.
Mailing Address - Street 2:STE 300
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104
Mailing Address - Country:US
Mailing Address - Phone:303-663-4366
Mailing Address - Fax:303-663-9466
Practice Address - Street 1:610 EAST 5TH ST.
Practice Address - Street 2:STE 300
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104
Practice Address - Country:US
Practice Address - Phone:303-663-4366
Practice Address - Fax:303-663-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty