Provider Demographics
NPI:1801863303
Name:PERIODONTAL ASSOCIATES
Entity type:Organization
Organization Name:PERIODONTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:VERSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-755-4500
Mailing Address - Street 1:2900 S PEORIA ST
Mailing Address - Street 2:BUILDING D
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3182
Mailing Address - Country:US
Mailing Address - Phone:303-755-4500
Mailing Address - Fax:303-755-4047
Practice Address - Street 1:2900 S PEORIA ST
Practice Address - Street 2:BUILDING D
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3182
Practice Address - Country:US
Practice Address - Phone:303-755-4500
Practice Address - Fax:303-755-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty