Healthcare Provider Details

I. General information

NPI: 1962411827
Provider Name (Legal Business Name): CATHERINE MARY FLAITZ DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13065 E. 17TH AVE, ROOM 130J MAIL STOP F844
DENVER CO
80203
US

IV. Provider business mailing address

13065 E. 17TH AVE, ROOM 130J MAIL STOP F844
DENVER CO
80203-2664
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-6983
  • Fax: 303-724-6986
Mailing address:
  • Phone: 303-724-6983
  • Fax: 303-724-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number17951
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number30-024363
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30-024363
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDEN.00105371
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: