Provider Demographics
NPI:1851538938
Name:PRAIRIE HAWK ORTHODONTICS, PC
Entity Type:Organization
Organization Name:PRAIRIE HAWK ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:STRUHS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-733-0353
Mailing Address - Street 1:3750 DACORO LN
Mailing Address - Street 2:SUITE 145
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-2501
Mailing Address - Country:US
Mailing Address - Phone:720-733-0353
Mailing Address - Fax:720-733-0360
Practice Address - Street 1:3750 DACORO LN
Practice Address - Street 2:SUITE 145
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-2501
Practice Address - Country:US
Practice Address - Phone:720-733-0353
Practice Address - Fax:720-733-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-89101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty