Provider Demographics
NPI:1952545261
Name:WILLOW RUN DENTAL, P.C.
Entity Type:Organization
Organization Name:WILLOW RUN DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:ROSANNE
Authorized Official - Last Name:MCMURTREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-280-8005
Mailing Address - Street 1:12910 ZUNI ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-1311
Mailing Address - Country:US
Mailing Address - Phone:720-872-2750
Mailing Address - Fax:720-872-2752
Practice Address - Street 1:12910 ZUNI ST
Practice Address - Street 2:SUITE 600
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-1311
Practice Address - Country:US
Practice Address - Phone:720-872-2750
Practice Address - Fax:720-872-2752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO74071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty