Provider Demographics
NPI:1972000933
Name:ROCKY MOUNTAIN ROOT CANAL SPECIALIST, PLLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN ROOT CANAL SPECIALIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-916-0381
Mailing Address - Street 1:10 STEWART CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6884
Mailing Address - Country:US
Mailing Address - Phone:303-916-0381
Mailing Address - Fax:
Practice Address - Street 1:13762 COLORADO BLVD UNIT 154
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-6919
Practice Address - Country:US
Practice Address - Phone:303-916-0381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.000102331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty