Provider Demographics
NPI:1134245863
Name:CASTLE ROCK DENTAL GROUP, P.C.
Entity type:Organization
Organization Name:CASTLE ROCK DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:ROWLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-663-6030
Mailing Address - Street 1:1001 S PERRY ST
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2668
Mailing Address - Country:US
Mailing Address - Phone:303-663-6030
Mailing Address - Fax:303-663-2632
Practice Address - Street 1:1001 S PERRY ST
Practice Address - Street 2:SUITE 104A
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2668
Practice Address - Country:US
Practice Address - Phone:303-663-6030
Practice Address - Fax:303-663-2632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1058161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty