Provider Demographics
NPI:1952510679
Name:JENNIFER L UNGER WATERS DDS PC
Entity Type:Organization
Organization Name:JENNIFER L UNGER WATERS DDS PC
Other - Org Name:CLEAR CREEK DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:UNGER
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-279-6621
Mailing Address - Street 1:1600 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1927
Mailing Address - Country:US
Mailing Address - Phone:303-279-6621
Mailing Address - Fax:303-216-0278
Practice Address - Street 1:1600 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1927
Practice Address - Country:US
Practice Address - Phone:303-279-6621
Practice Address - Fax:303-216-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8005261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1588647176OtherNPI
CO=========OtherTIN