Healthcare Provider Details

I. General information

NPI: 1477489094
Provider Name (Legal Business Name): ROCKY MOUNTAIN DENTURE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2726 W 11TH STREET RD
GREELEY CO
80634-5408
US

IV. Provider business mailing address

2726 W 11TH STREET RD
GREELEY CO
80634-5408
US

V. Phone/Fax

Practice location:
  • Phone: 303-834-5723
  • Fax:
Mailing address:
  • Phone: 303-834-5723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN C LEWIS
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 303-834-5723