Healthcare Provider Details

I. General information

NPI: 1780646604
Provider Name (Legal Business Name): COLORADO LASER DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 PINE GROVE RD STE 101A
STEAMBOAT SPRINGS CO
80487
US

IV. Provider business mailing address

1495 PINE GROVE RD STE 101A
STEAMBOAT SPRINGS CO
80487-8815
US

V. Phone/Fax

Practice location:
  • Phone: 970-871-4611
  • Fax:
Mailing address:
  • Phone: 719-648-9982
  • Fax: 970-879-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7370
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7370
License Number StateCO

VIII. Authorized Official

Name: DR. JEFFREY JOEL HARRISON
Title or Position: PRESIDENT
Credential: DDS
Phone: 719-648-9982