Healthcare Provider Details

I. General information

NPI: 1316068729
Provider Name (Legal Business Name): PERFECT TEETH - YALE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 W YALE AVE SUITE A
DENVER CO
80227-3423
US

IV. Provider business mailing address

7515 W YALE AVE SUITE A
DENVER CO
80227-3423
US

V. Phone/Fax

Practice location:
  • Phone: 303-988-3319
  • Fax: 303-988-3492
Mailing address:
  • Phone: 303-988-3319
  • Fax: 303-988-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6097
License Number StateCO

VIII. Authorized Official

Name: LAURIE SUMMERS
Title or Position: CREDENTIALING
Credential:
Phone: 303-285-6098