Provider Demographics
NPI:1831529734
Name:DENTAL ARTS OF EAGLE
Entity type:Organization
Organization Name:DENTAL ARTS OF EAGLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAINHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-328-6347
Mailing Address - Street 1:P.O. BOX 840
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631
Mailing Address - Country:US
Mailing Address - Phone:970-328-6347
Mailing Address - Fax:970-328-6375
Practice Address - Street 1:112 WEST 6TH STREET
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-0840
Practice Address - Country:US
Practice Address - Phone:970-328-6347
Practice Address - Fax:970-328-6375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO59181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty