Provider Demographics
NPI:1780134999
Name:TWIN PEAKS DENTAL & ORTHODONTICS
Entity type:Organization
Organization Name:TWIN PEAKS DENTAL & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-774-8300
Mailing Address - Street 1:1325 DRY CREEK DR STE 206
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7748
Mailing Address - Country:US
Mailing Address - Phone:303-774-8300
Mailing Address - Fax:
Practice Address - Street 1:1325 DRY CREEK DR STE 206
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-7748
Practice Address - Country:US
Practice Address - Phone:303-774-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10514122300000X
CO201865122300000X
CO00201981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty