Healthcare Provider Details

I. General information

NPI: 1508197294
Provider Name (Legal Business Name): MOUNTAIN TOP PERIODONTICS AND IMPLANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 E PRENTICE AVE #D-7
GREENWOOD VILLAGE CO
80111-2744
US

IV. Provider business mailing address

8000 E PRENTICE AVE #D-7
GREENWOOD VILLAGE CO
80111-2744
US

V. Phone/Fax

Practice location:
  • Phone: 303-740-0080
  • Fax: 303-740-7481
Mailing address:
  • Phone: 303-740-0080
  • Fax: 303-740-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number8094
License Number StateCO

VIII. Authorized Official

Name: MS. BARBARA J LEITNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-740-0080