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General NPI Number Information
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NPI Number | 1083455067
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Entity Type | Individual
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Provider Name | COLLIN LOUSTALET
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Gender | Male
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 15250 E ORCHARD RD
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City | CENTENNIAL
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State | CO
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Zip | 80016-3003
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Country | US
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Telephone | 303-680-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 17480 E CLOUDBERRY DR
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City | PARKER
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State | CO
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Zip | 80134-8848
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Country | US
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Telephone | 303-345-1660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN.00205967
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 182
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License Number State | NE
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