Healthcare Provider Details

I. General information

NPI: 1245412436
Provider Name (Legal Business Name): KIDS & FAMILY DENTISTRY & ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E 120TH AVE SUITE #104
THORNTON CO
80233-2484
US

IV. Provider business mailing address

2300 E 120TH AVE SUITE #104
THORNTON CO
80233-2484
US

V. Phone/Fax

Practice location:
  • Phone: 303-254-8828
  • Fax: 303-254-8827
Mailing address:
  • Phone: 303-254-8828
  • Fax: 303-254-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER H KO
Title or Position: OPERATING MANAGER
Credential:
Phone: 303-254-8828