Provider Demographics
NPI:1669917704
Name:COLORADO MOBILE DENTAL LLC
Entity type:Organization
Organization Name:COLORADO MOBILE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-810-5619
Mailing Address - Street 1:8000 S LINCOLN ST
Mailing Address - Street 2:SUITE 2-4
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2714
Mailing Address - Country:US
Mailing Address - Phone:303-810-5619
Mailing Address - Fax:303-265-9498
Practice Address - Street 1:8000 S LINCOLN ST
Practice Address - Street 2:SUITE 2-4
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2714
Practice Address - Country:US
Practice Address - Phone:303-810-5619
Practice Address - Fax:303-265-9498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty