Provider Demographics
NPI:1942382999
Name:DARRELL L HAVENERS JR DDS PC
Entity Type:Organization
Organization Name:DARRELL L HAVENERS JR DDS PC
Other - Org Name:HIGHLANDS RANCH ORTHODONTICS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAVENER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-791-2021
Mailing Address - Street 1:1420 W CANAL CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120
Mailing Address - Country:US
Mailing Address - Phone:303-791-2021
Mailing Address - Fax:303-791-0327
Practice Address - Street 1:1420 W CANAL CT
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120
Practice Address - Country:US
Practice Address - Phone:303-791-2021
Practice Address - Fax:303-791-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty