Provider Demographics
NPI:1952549636
Name:THE LIONS TOOTH, LLC
Entity Type:Organization
Organization Name:THE LIONS TOOTH, LLC
Other - Org Name:CARBON VALLEY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHULZE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-833-5500
Mailing Address - Street 1:2146 REDFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-9810
Mailing Address - Country:US
Mailing Address - Phone:303-833-5500
Mailing Address - Fax:866-514-8749
Practice Address - Street 1:630 MAIN STREET
Practice Address - Street 2:UNIT B
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80530
Practice Address - Country:US
Practice Address - Phone:303-833-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9053261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental