Healthcare Provider Details

I. General information

NPI: 1003433251
Provider Name (Legal Business Name): MERIDIAN ENDODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10107 RIDGEGATE PKWY # G020
LONE TREE CO
80124-5637
US

IV. Provider business mailing address

10107 RIDGEGATE PKWY # G020
LONE TREE CO
80124-5637
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-2221
  • Fax:
Mailing address:
  • Phone: 720-507-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KERRI L LAWLOR
Title or Position: OWNER/ENDODONTIST
Credential: DDS
Phone: 303-507-2239