Provider Demographics
NPI:1013335918
Name:M. DENTAL, P.C.
Entity Type:Organization
Organization Name:M. DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:LYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-333-7733
Mailing Address - Street 1:1777 S HARRISON ST
Mailing Address - Street 2:STE. 1250
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3925
Mailing Address - Country:US
Mailing Address - Phone:303-333-7733
Mailing Address - Fax:
Practice Address - Street 1:745 S. GARTRELL RD.
Practice Address - Street 2:UNIT A9
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-2439
Practice Address - Country:US
Practice Address - Phone:303-840-9447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty