Healthcare Provider Details

I. General information

NPI: 1508775016
Provider Name (Legal Business Name): WEST LAKE DENTAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W EISENHOWER BLVD STE 200
LOVELAND CO
80537-3165
US

IV. Provider business mailing address

650 W EISENHOWER BLVD STE 200
LOVELAND CO
80537-3165
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-1444
  • Fax: 970-669-1445
Mailing address:
  • Phone: 970-669-1444
  • Fax: 970-669-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MAPLES
Title or Position: OWNER
Credential: DDS
Phone: 970-669-1444