Healthcare Provider Details

I. General information

NPI: 1225701212
Provider Name (Legal Business Name): RED ROCKS ENDODONTICS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 W 41ST AVE UNIT 202
WHEAT RIDGE CO
80033-4123
US

IV. Provider business mailing address

10050 W 41ST AVE UNIT 202
WHEAT RIDGE CO
80033-4123
US

V. Phone/Fax

Practice location:
  • Phone: 303-232-1327
  • Fax: 303-232-6154
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MIKE COLE
Title or Position: VP INSURANCE PLAN MANAGEMENT
Credential:
Phone: 727-424-2990