Healthcare Provider Details

I. General information

NPI: 1184902132
Provider Name (Legal Business Name): LAYCOCK DENTISTRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 DARLEY AVE SUITE 7
BOULDER CO
80305-6557
US

IV. Provider business mailing address

4150 DARLEY AVE SUITE 7
BOULDER CO
80305-6557
US

V. Phone/Fax

Practice location:
  • Phone: 303-494-1550
  • Fax:
Mailing address:
  • Phone: 303-494-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7068
License Number StateTX

VII. Legacy identifiers

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

VIII. Authorized Official

Name: STEPHEN W LAYCOCK
Title or Position: OWNER
Credential:
Phone: 303-494-1550