Provider Demographics
NPI:1265804355
Name:NEO KIDS DENTISTRY & THE NEW ORTHODONTICS
Entity type:Organization
Organization Name:NEO KIDS DENTISTRY & THE NEW ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:LAUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:303-690-0400
Mailing Address - Street 1:14991 E HAMPDEN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9400 STATION ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6808
Practice Address - Country:US
Practice Address - Phone:303-690-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN000007581223X0400X
CODEN002020831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty