Healthcare Provider Details

I. General information

NPI: 1730244740
Provider Name (Legal Business Name): KIDS IN NEED OF DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7190 COLORADO BLVD STE 300
DENVER CO
80022-1808
US

IV. Provider business mailing address

7190 COLORADO BLVD STE 300
COMMERCE CITY CO
80022-1808
US

V. Phone/Fax

Practice location:
  • Phone: 303-733-3710
  • Fax:
Mailing address:
  • Phone: 303-733-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number201198
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number201877
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: ELLIE BURBEE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 720-795-9791