Provider Demographics
NPI:1952809964
Name:LARIMER SQUARE PROFESSIONAL DENTAL GROUP LLC
Entity Type:Organization
Organization Name:LARIMER SQUARE PROFESSIONAL DENTAL GROUP LLC
Other - Org Name:COMFORT DENTAL LARIMER SQUARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-862-0297
Mailing Address - Street 1:16981 E QUINCY AVE # D1-D3
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2769
Mailing Address - Country:US
Mailing Address - Phone:303-617-8400
Mailing Address - Fax:303-617-3516
Practice Address - Street 1:1512 LARIMER ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1610
Practice Address - Country:US
Practice Address - Phone:303-617-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty