1265804355 NPI number — NEO KIDS DENTISTRY & THE NEW ORTHODONTICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265804355 NPI number — NEO KIDS DENTISTRY & THE NEW ORTHODONTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEO KIDS DENTISTRY & THE NEW ORTHODONTICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1265804355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14991 E HAMPDEN AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80014-3987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9400 STATION ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124-6808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-690-0400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LAUSON
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
KENT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-690-0400

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  DEN00000758 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: DEN00202083 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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