Healthcare Provider Details

I. General information

NPI: 1154135481
Provider Name (Legal Business Name): DDS ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 MARKET ST STE B
DENVER CO
80202-2749
US

IV. Provider business mailing address

11765 ASH DR
THORNTON CO
80233-5114
US

V. Phone/Fax

Practice location:
  • Phone: 248-760-4262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DESIREA SCOTT-MOORE
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 248-760-4262