Provider Demographics
NPI:1356796841
Name:THAI DENTAL PC
Entity type:Organization
Organization Name:THAI DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MINH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-653-3020
Mailing Address - Street 1:1580 W 141ST WAY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8459
Mailing Address - Country:US
Mailing Address - Phone:303-653-3020
Mailing Address - Fax:
Practice Address - Street 1:810 E 88TH AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4747
Practice Address - Country:US
Practice Address - Phone:303-254-8828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6457347Medicaid