Provider Demographics
NPI:1023531647
Name:CHARISMA FAMILY DENTISTRY
Entity type:Organization
Organization Name:CHARISMA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-609-6611
Mailing Address - Street 1:1880 S PIERCE ST STE 16B
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-7143
Mailing Address - Country:US
Mailing Address - Phone:303-953-1418
Mailing Address - Fax:720-524-4411
Practice Address - Street 1:1880 S PIERCE ST STE 16B
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7143
Practice Address - Country:US
Practice Address - Phone:303-953-1418
Practice Address - Fax:720-524-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN002027931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty