Healthcare Provider Details

I. General information

NPI: 1942601034
Provider Name (Legal Business Name): G & T ENTERPRISES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 HIGH ST
DENVER CO
80205-4062
US

IV. Provider business mailing address

3216 HIGH ST
DENVER CO
80205-4062
US

V. Phone/Fax

Practice location:
  • Phone: 303-329-0231
  • Fax: 303-329-4622
Mailing address:
  • Phone: 303-329-0231
  • Fax: 303-329-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateCO

VIII. Authorized Official

Name: KIMBERLY MCCLESKEY
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 303-521-2560