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General NPI Number Information
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NPI Number | 1679731764
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL ASSOCIATES OF COLORADO
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 3795 S COLORADO BLVD
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City | ENGLEWOOD
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State | CO
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Zip | 80113-4202
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Country | US
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Telephone | 303-522-4703
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Fax |
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Provider Business Mailing Address
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Address Line | 730 POTOMAC ST #306
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City | AURORA
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State | CO
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Zip | 80011-6703
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Country | US
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Telephone | 303-537-0234
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Fax | 720-858-8248
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA CARLSON-MARKS
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Credential | DDS
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Telephone | 303-594-2214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7396
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License Number State | CO
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