Provider Demographics
NPI:1184870842
Name:FOOTHILLS ENDODONTIC SPECIALISTS, PROF. LLC
Entity type:Organization
Organization Name:FOOTHILLS ENDODONTIC SPECIALISTS, PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:RING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:720-317-2660
Mailing Address - Street 1:2861 W 120TH AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2985
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2861 W 120TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2985
Practice Address - Country:US
Practice Address - Phone:720-317-2660
Practice Address - Fax:720-317-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty