Provider Demographics
NPI:1811245871
Name:APPLETREE DENTAL PROFESSIONAL LLC
Entity type:Organization
Organization Name:APPLETREE DENTAL PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DERBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-872-2892
Mailing Address - Street 1:2800 E 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3417
Mailing Address - Country:US
Mailing Address - Phone:720-872-2892
Mailing Address - Fax:720-872-2894
Practice Address - Street 1:2800 E 136TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3417
Practice Address - Country:US
Practice Address - Phone:720-872-2892
Practice Address - Fax:720-872-2894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty