Provider Demographics
NPI:1720497431
Name:JEFFREY T. LODL, D.D.S
Entity Type:Organization
Organization Name:JEFFREY T. LODL, D.D.S
Other - Org Name:ARVADA WEST DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:LODL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-424-0767
Mailing Address - Street 1:5730 WARD RD
Mailing Address - Street 2:STE. 204
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002
Mailing Address - Country:US
Mailing Address - Phone:303-424-0767
Mailing Address - Fax:303-424-7324
Practice Address - Street 1:5730 WARD RD
Practice Address - Street 2:STE. 204
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1300
Practice Address - Country:US
Practice Address - Phone:303-424-0767
Practice Address - Fax:303-424-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1062801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty