Healthcare Provider Details

I. General information

NPI: 1841040243
Provider Name (Legal Business Name): PEDIATRIC SEDATION DENTISTRY OF COLORADO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 S LINCOLN AVE
SIOUX FALLS SD
57105-5224
US

IV. Provider business mailing address

2755 ELIOT ST
DENVER CO
80211-4111
US

V. Phone/Fax

Practice location:
  • Phone: 720-828-2106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW LUCERO
Title or Position: OWNER
Credential: DMD
Phone: 720-828-2106