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General NPI Number Information
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NPI Number | 1124466727
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Entity Type | Organization
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Legal Business Name | DENTISTRY AT GOLDEN RIDGE
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 06/05/2013
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Provider Practice Location Address
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Address Line | 755 HERITAGE RD STE 120
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City | GOLDEN
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State | CO
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Zip | 80401-3600
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Country | US
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Telephone | 303-395-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 755 HERITAGE RD STE 120
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City | GOLDEN
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State | CO
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Zip | 80401-3600
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Country | US
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Telephone | 303-395-3333
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. JAMIE IRWIN RICHARD
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Credential | DDS
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Telephone | 303-204-6339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9903
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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 | 9697
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License Number State | CO
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