Healthcare Provider Details

I. General information

NPI: 1265804355
Provider Name (Legal Business Name): NEO KIDS DENTISTRY & THE NEW ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 STATION ST SUITE 100
LONE TREE CO
80124-6808
US

IV. Provider business mailing address

14991 E HAMPDEN AVE STE 300
AURORA CO
80014-3987
US

V. Phone/Fax

Practice location:
  • Phone: 303-690-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN00000758
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN00202083
License Number StateCO

VIII. Authorized Official

Name: SAMUEL KENT LAUSON
Title or Position: OWNER
Credential: DDS, MS
Phone: 303-690-0400