Provider Demographics
NPI:1750990032
Name:WEST ARVADA FAMILY DENTAL PLLC
Entity type:Organization
Organization Name:WEST ARVADA FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERAMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-635-2684
Mailing Address - Street 1:9415 JOYCE WAY
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7501
Mailing Address - Country:US
Mailing Address - Phone:720-635-2684
Mailing Address - Fax:
Practice Address - Street 1:18068 W 92ND LN UNIT 100
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-8162
Practice Address - Country:US
Practice Address - Phone:720-635-2684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental