Provider Demographics
NPI:1982826517
Name:PEDIATRIC DENTICARE, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC DENTICARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PURVI
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MS NUTRITION,DDS,PD
Authorized Official - Phone:303-663-3388
Mailing Address - Street 1:3750 DACORO LN STE 120
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-2502
Mailing Address - Country:US
Mailing Address - Phone:303-663-3388
Mailing Address - Fax:303-221-1264
Practice Address - Street 1:3750 DACORO LN STE 120
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-2502
Practice Address - Country:US
Practice Address - Phone:303-663-3388
Practice Address - Fax:303-221-1264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty