Provider Demographics
NPI:1952565996
Name:CHILDREN'S DENTAL CENTER
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL CENTER
Other - Org Name:JOHN R, SEXTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-984-9700
Mailing Address - Street 1:2323 SOUTH WADSWORTH BLVD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227
Mailing Address - Country:US
Mailing Address - Phone:303-984-9700
Mailing Address - Fax:303-985-2490
Practice Address - Street 1:2323 SOUTH WADSWORTH BLVD
Practice Address - Street 2:SUITE #104
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227
Practice Address - Country:US
Practice Address - Phone:303-984-9700
Practice Address - Fax:303-985-2490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN R, SEXTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-17
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02047082Medicaid
CO04104709Medicaid
CO39009777Medicaid
CO02047082Medicaid