Provider Demographics
NPI:1245412436
Name:KIDS & FAMILY DENTISTRY & ORTHODONTICS
Entity type:Organization
Organization Name:KIDS & FAMILY DENTISTRY & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:H
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-254-8828
Mailing Address - Street 1:2300 E 120TH AVE
Mailing Address - Street 2:SUITE #104
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-2484
Mailing Address - Country:US
Mailing Address - Phone:303-254-8828
Mailing Address - Fax:303-254-8827
Practice Address - Street 1:2300 E 120TH AVE
Practice Address - Street 2:SUITE #104
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-2484
Practice Address - Country:US
Practice Address - Phone:303-254-8828
Practice Address - Fax:303-254-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty