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General NPI Number Information
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NPI Number | 1154576858
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Entity Type | Organization
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Legal Business Name | LITTLETON MOBILE DENTISTRY
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 1200 S WADSWORTH BLVD SUITE 300
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City | LAKEWOOD
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State | CO
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Zip | 80232-5473
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Country | US
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Telephone | 303-922-1119
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Fax | 303-922-1145
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Provider Business Mailing Address
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Address Line | 1200 S WADSWORTH BLVD SUITE 300
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City | LAKEWOOD
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State | CO
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Zip | 80232-5473
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Country | US
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Telephone | 303-922-1119
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Fax | 303-922-1145
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JOSH FREIBERG
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Credential |
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Telephone | 303-922-1119
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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 | 7815
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License Number State | CO
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