Provider Demographics
NPI:1649405333
Name:LERE, ANTHONY RYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:RYAN
Last Name:LERE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11078 CIMARRON ST UNIT H
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6600
Mailing Address - Country:US
Mailing Address - Phone:303-485-6595
Mailing Address - Fax:
Practice Address - Street 1:11078 CIMARRON ST UNIT H
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6600
Practice Address - Country:US
Practice Address - Phone:303-485-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-25
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO2018081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program