Provider Demographics
NPI:1023119203
Name:PAUL ANDREATTA D.D.S.P.C.
Entity type:Organization
Organization Name:PAUL ANDREATTA D.D.S.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDREATTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-846-4028
Mailing Address - Street 1:1723 E. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082
Mailing Address - Country:US
Mailing Address - Phone:719-846-4028
Mailing Address - Fax:719-845-0097
Practice Address - Street 1:1723 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082
Practice Address - Country:US
Practice Address - Phone:719-846-4028
Practice Address - Fax:719-845-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COBLUE CROSS BLUE SHIEOtherBLUE CROSS BLUE SHIELD
CODELTA DENTALOtherDELTA DENTAL
COAETNA HEALTH PLAN UPOtherAETNA HEALTH UPS