Provider Demographics
NPI:1003639071
Name:SUITE 305 LLC
Entity type:Organization
Organization Name:SUITE 305 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KONSTANTINOS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAROGIANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-985-1263
Mailing Address - Street 1:7373 W JEFFERSON AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2021
Mailing Address - Country:US
Mailing Address - Phone:303-985-1263
Mailing Address - Fax:303-985-1659
Practice Address - Street 1:7373 W JEFFERSON AVE STE 305
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2021
Practice Address - Country:US
Practice Address - Phone:303-985-1263
Practice Address - Fax:303-985-1659
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAMPDEN AVE DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental