Provider Demographics
NPI:1851739122
Name:GREEN VALLEY RANCH DENTAL PARTNERS
Entity Type:Organization
Organization Name:GREEN VALLEY RANCH DENTAL PARTNERS
Other - Org Name:COMFORT DENTAL GREEN VALLEY RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-371-8247
Mailing Address - Street 1:18620 GREEN VALLEY RANCH BOULEVARD
Mailing Address - Street 2:SUITE NUMBER 103
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249
Mailing Address - Country:US
Mailing Address - Phone:303-371-8247
Mailing Address - Fax:
Practice Address - Street 1:18620 GREEN VALLEY RANCH BOULEVARD
Practice Address - Street 2:SUITE NUMBER 103
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249
Practice Address - Country:US
Practice Address - Phone:303-371-8247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty