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General NPI Number Information
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NPI Number | 1679740278
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Entity Type | Organization
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Legal Business Name | LAKEWOOD FAMILY DENTISTRY, P.C.
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 7700 W 14TH AVE
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City | LAKEWOOD
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State | CO
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Zip | 80214-4110
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Country | US
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Telephone | 303-237-4831
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Fax | 303-237-2214
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Provider Business Mailing Address
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Address Line | 7700 W 14TH AVE
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City | LAKEWOOD
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State | CO
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Zip | 80214-4110
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Country | US
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Telephone | 303-237-4831
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Fax | 303-237-2214
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | TRENT MATTHEW ROLD
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Credential | D.D.S.
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Telephone | 303-237-4831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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