Healthcare Provider Details

I. General information

NPI: 1043648314
Provider Name (Legal Business Name): SAUNDERS PERIODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 ALLISON WAY
ARVADA CO
80005-4428
US

IV. Provider business mailing address

7975 ALLISON WAY
ARVADA CO
80005-4428
US

V. Phone/Fax

Practice location:
  • Phone: 303-420-0535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10262
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier65556364
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: DR. MADELINE SAUNDERS
Title or Position: OWNER/PERIODONTIST
Credential: DDS, MSD
Phone: 303-420-0535