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General NPI Number Information
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NPI Number | 1003227794
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Entity Type | Organization
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Legal Business Name | TOTAL ORTHODONTICS PROFESSIONAL LLP
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 10450 PARK MEADOWS DR STE 300
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City | LONE TREE
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State | CO
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Zip | 80124-5530
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Country | US
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Telephone | 303-779-0565
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Fax | 303-804-5394
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Provider Business Mailing Address
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Address Line | 10450 PARK MEADOWS DR STE 300
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City | LONE TREE
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State | CO
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Zip | 80124-5530
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Country | US
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Telephone | 303-779-0565
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Fax | 303-804-5394
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. KEVIN L. THEROUX
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Credential | D.D.S., M.S.
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Telephone | 303-779-0565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 00010417
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7495
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License Number State | CO
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