Provider Demographics
NPI:1336371483
Name:ENDODONTICS OF COLORADO
Entity Type:Organization
Organization Name:ENDODONTICS OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LASHANDA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-696-1919
Mailing Address - Street 1:11200 E MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3260
Mailing Address - Country:US
Mailing Address - Phone:303-696-1919
Mailing Address - Fax:303-696-1958
Practice Address - Street 1:11200 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3260
Practice Address - Country:US
Practice Address - Phone:303-696-1919
Practice Address - Fax:303-696-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80631223E0200X
CO86461223E0200X
CO70871223E0200X
CO93851223E0200X
CO75071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty