Provider Demographics
NPI:1841757028
Name:ELEVATED DENTAL
Entity Type:Organization
Organization Name:ELEVATED DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-728-3665
Mailing Address - Street 1:PO BOX 2439
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-2439
Mailing Address - Country:US
Mailing Address - Phone:970-728-3665
Mailing Address - Fax:970-728-6589
Practice Address - Street 1:101 E COLORADO AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-728-3665
Practice Address - Fax:970-728-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1093096315OtherNON-MEDICARE