Provider Demographics
NPI:1356800783
Name:KIDS TOOTH DOC - PARKER
Entity type:Organization
Organization Name:KIDS TOOTH DOC - PARKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-947-7705
Mailing Address - Street 1:18801 E MAINSTREET
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3473
Mailing Address - Country:US
Mailing Address - Phone:303-947-7705
Mailing Address - Fax:
Practice Address - Street 1:18801 E MAINSTREET
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3473
Practice Address - Country:US
Practice Address - Phone:303-947-7705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty