Provider Demographics
NPI:1841863248
Name:CHILDREN'S DENTISTRY LLC
Entity type:Organization
Organization Name:CHILDREN'S DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-635-9251
Mailing Address - Street 1:6900 YELLOWTAIL RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-6102
Mailing Address - Country:US
Mailing Address - Phone:307-635-9251
Mailing Address - Fax:307-635-9218
Practice Address - Street 1:5100 W 20TH ST STE B
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3051
Practice Address - Country:US
Practice Address - Phone:970-373-4435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty