=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528265840
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CD LOUISVILLE PROF.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2007
-----------------------------------------------------
Last Update Date | 08/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 339 MCCASLIN BLVD UNIT B
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80027-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-673-0500
-----------------------------------------------------
Fax | 303-673-0505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 339 MCCASLIN BLVD UNIT B
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80027-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-673-0500
-----------------------------------------------------
Fax | 303-673-0505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. RALPH MASON DOWNEY
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 303-673-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6480
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 9422
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 9306
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------