Provider Demographics
NPI:1669930319
Name:LINKED TO CRAIG 501C3
Entity type:Organization
Organization Name:LINKED TO CRAIG 501C3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LINK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-773-8262
Mailing Address - Street 1:9085 E. MINERAL CIRCLE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:303-773-8262
Mailing Address - Fax:303-773-8262
Practice Address - Street 1:9085 E. MINERAL CIRCLE
Practice Address - Street 2:SUITE 350
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-773-8262
Practice Address - Fax:303-773-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60889357Medicaid