Healthcare Provider Details

I. General information

NPI: 1881717007
Provider Name (Legal Business Name): PEDIATRIC DENTISTRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10184 W BELLEVIEW AVE SUITE 110
LITTLETON CO
80127-1700
US

IV. Provider business mailing address

10184 W BELLEVIEW AVE SUITE 110
LITTLETON CO
80127-1700
US

V. Phone/Fax

Practice location:
  • Phone: 303-973-4424
  • Fax: 303-973-4427
Mailing address:
  • Phone: 303-973-4424
  • Fax: 303-973-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number104978
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number104977
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number104977
License Number StateCO

VIII. Authorized Official

Name: DR. IRA N MOYER
Title or Position: SECRETARY-TREASURER
Credential: D.D.S
Phone: 303-973-4424