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NPI Code Detail

MEDICARE: COMMERCE CITY KIDS & FAMILY DENTAL, PLLC

MEDICARE: COMMERCE CITY KIDS & FAMILY DENTAL, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1265073233
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMERCE CITY KIDS & FAMILY DENTAL, PLLC
Provider Business Mailing Address
First Line : 3825 PIERSON CT
Second Line :
City : WHEAT RIDGE
State : CO
Zip : 80033-3983
Country : US
Telephone Number : 520-252-9551
Fax Number :
Provider Business Practice Location Address
First Line : 4972 E 62ND AVE UNIT B1
Second Line :
City : COMMERCE CITY
State : CO
Zip : 80022-3253
Country : US
Telephone Number : 303-288-4969
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : SONYA VILLARREAL
Credential : DDS
Telephone Number : 520-252-9551
Provider Enumeration Date : 10/01/2019
Last Update Date : 10/01/2019

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