Provider Demographics
NPI:1649693383
Name:ROGER B. ELTON, D.D.S., P.C.
Entity type:Organization
Organization Name:ROGER B. ELTON, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:B
Authorized Official - Last Name:ELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DD S
Authorized Official - Phone:303-364-6433
Mailing Address - Street 1:5657 S HIMALAYA ST STE 110
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5308
Mailing Address - Country:US
Mailing Address - Phone:303-364-6433
Mailing Address - Fax:303-699-8246
Practice Address - Street 1:5657 S HIMALAYA ST STE 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-5308
Practice Address - Country:US
Practice Address - Phone:303-364-6433
Practice Address - Fax:303-699-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty