Healthcare Provider Details

I. General information

NPI: 1821042896
Provider Name (Legal Business Name): GREGG LAWRENCE LURCOTT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S COLORADO BLVD SUITE 450
DENVER CO
80246-1253
US

IV. Provider business mailing address

2 GOOSEBERRY LN
ENGLEWOOD CO
80113-4126
US

V. Phone/Fax

Practice location:
  • Phone: 303-744-1369
  • Fax: 303-744-9879
Mailing address:
  • Phone: 303-744-1369
  • Fax: 303-744-9879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901017646
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9835
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: