Healthcare Provider Details

I. General information

NPI: 1245766476
Provider Name (Legal Business Name): RITE OF PASSAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2017
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28101 E QUINCY AVE
WATKINS CO
80137-9502
US

IV. Provider business mailing address

2560 BUSINESS PKWY SUITE A
MINDEN NV
89423-8985
US

V. Phone/Fax

Practice location:
  • Phone: 303-766-3000
  • Fax:
Mailing address:
  • Phone: 775-392-2657
  • Fax: 775-392-2455

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: KRISTINA CRANDELL
Title or Position: LEAD A/R CLERK
Credential:
Phone: 775-392-2657