Provider Demographics
NPI:1659491546
Name:PERFECT TEETH - 64TH AND WARD P.C.
Entity type:Organization
Organization Name:PERFECT TEETH - 64TH AND WARD P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-285-6098
Mailing Address - Street 1:12650 W 64TH AVE
Mailing Address - Street 2:UNIT J
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-3893
Mailing Address - Country:US
Mailing Address - Phone:303-423-9000
Mailing Address - Fax:303-423-8249
Practice Address - Street 1:12650 W 64TH AVE
Practice Address - Street 2:UNIT J
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-3893
Practice Address - Country:US
Practice Address - Phone:303-423-9000
Practice Address - Fax:303-423-8249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty