Healthcare Provider Details

I. General information

NPI: 1255543393
Provider Name (Legal Business Name): LODO DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 WAZEE ST STE 102
DENVER CO
80202-1491
US

IV. Provider business mailing address

1435 WAZEE ST STE 102
DENVER CO
80202-1491
US

V. Phone/Fax

Practice location:
  • Phone: 303-623-5636
  • Fax: 303-623-5640
Mailing address:
  • Phone: 303-623-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8980
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE KIKUE FURUTA GRIFFITH
Title or Position: OWNER
Credential: DDS
Phone: 303-623-5636