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General NPI Number Information
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NPI Number | 1265804355
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Entity Type | Organization
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Legal Business Name | NEO KIDS DENTISTRY & THE NEW ORTHODONTICS
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 9400 STATION ST SUITE 100
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City | LONE TREE
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State | CO
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Zip | 80124-6808
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Country | US
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Telephone | 303-690-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 14991 E HAMPDEN AVE STE 300
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City | AURORA
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State | CO
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Zip | 80014-3987
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL KENT LAUSON
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Credential | DDS, MS
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Telephone | 303-690-0400
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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 | DEN00000758
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN00202083
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License Number State | CO
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