1174740187 NPI number — MRS. MARIA ELENA BUTLER BALLONA

Table of content: MRS. MARIA ELENA BUTLER BALLONA (NPI 1174740187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174740187 NPI number — MRS. MARIA ELENA BUTLER BALLONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER BALLONA
Provider First Name:
MARIA
Provider Middle Name:
ELENA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174740187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
274 S MEADE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80219-1940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-837-8825
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 WADSWORTH BLVD STE 18A
Provider Second Line Business Practice Location Address:
ALL ABOUT KIDS DENTAL CENTER
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80214-5730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-431-1221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 126800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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