Healthcare Provider Details

I. General information

NPI: 1376716134
Provider Name (Legal Business Name): PLOUS AND ADLER FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 W 20TH AVE
LAKEWOOD CO
80214-5738
US

IV. Provider business mailing address

7575 W 20TH AVE
LAKEWOOD CO
80214-5738
US

V. Phone/Fax

Practice location:
  • Phone: 303-234-1112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0649
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8533
License Number StateCO

VIII. Authorized Official

Name: DR. ERIC ADLER
Title or Position: OWNER/DENTIST
Credential:
Phone: 303-234-1112