Provider Demographics
NPI:1942868690
Name:ROCKY MOUNTAIN DENTAL ANESTHESIA
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN DENTAL ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-367-2336
Mailing Address - Street 1:811 BRICKYARD CIR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-8058
Mailing Address - Country:US
Mailing Address - Phone:559-367-2336
Mailing Address - Fax:
Practice Address - Street 1:811 BRICKYARD CIR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-8058
Practice Address - Country:US
Practice Address - Phone:559-367-2336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Single Specialty