Provider Demographics
NPI:1972819415
Name:MONACO DENTAL ASSOCIATES DBA HAPPY TEETH
Entity Type:Organization
Organization Name:MONACO DENTAL ASSOCIATES DBA HAPPY TEETH
Other - Org Name:MONACO DENTAL ASSOCIATES GP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-359-9051
Mailing Address - Street 1:1570 E. COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218
Mailing Address - Country:US
Mailing Address - Phone:303-495-2535
Mailing Address - Fax:
Practice Address - Street 1:1570 E. COLFAX AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218
Practice Address - Country:US
Practice Address - Phone:303-495-2535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-22
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO97471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty