Provider Demographics
NPI:1770311953
Name:CENTENNIAL GRIN ORTHO, PLLC
Entity type:Organization
Organization Name:CENTENNIAL GRIN ORTHO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:COLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-277-5930
Mailing Address - Street 1:7999 S COUNTRY CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1195
Mailing Address - Country:US
Mailing Address - Phone:720-579-8855
Mailing Address - Fax:
Practice Address - Street 1:6870 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1515
Practice Address - Country:US
Practice Address - Phone:720-277-5930
Practice Address - Fax:303-330-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty