Provider Demographics
NPI:1770843591
Name:COLORADO FAMILY DENTISTRY, P.C.
Entity type:Organization
Organization Name:COLORADO FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:KASPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-284-0202
Mailing Address - Street 1:255 UNION BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1810
Mailing Address - Country:US
Mailing Address - Phone:303-284-0202
Mailing Address - Fax:303-284-0404
Practice Address - Street 1:255 UNION BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1810
Practice Address - Country:US
Practice Address - Phone:303-284-0202
Practice Address - Fax:303-284-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-26
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty