Provider Demographics
NPI:1891994257
Name:COURTNEY R. COLLEGE, DDS, MS, PC
Entity Type:Organization
Organization Name:COURTNEY R. COLLEGE, DDS, MS, PC
Other - Org Name:KIDS TO COLLEGE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLLEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-979-9500
Mailing Address - Street 1:10146 W SAN JUAN WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6326
Mailing Address - Country:US
Mailing Address - Phone:303-979-9500
Mailing Address - Fax:303-979-0140
Practice Address - Street 1:10146 W SAN JUAN WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-6326
Practice Address - Country:US
Practice Address - Phone:303-979-9500
Practice Address - Fax:303-979-0140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71853073Medicaid