Provider Demographics
NPI:1649904236
Name:GARLOCK FIRESTONE ORTHODONTICS LLC
Entity type:Organization
Organization Name:GARLOCK FIRESTONE ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-848-3633
Mailing Address - Street 1:8310 COLORADO BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6813
Mailing Address - Country:US
Mailing Address - Phone:303-848-3633
Mailing Address - Fax:303-253-9213
Practice Address - Street 1:8310 COLORADO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6813
Practice Address - Country:US
Practice Address - Phone:303-848-3633
Practice Address - Fax:303-253-9213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty