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General NPI Number Information
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NPI Number | 1740306166
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Entity Type | Organization
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Legal Business Name | W.J. PONTARELLI, JR., D.D.S., P.C.
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15 WADSWORTH BLVD
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City | LAKEWOOD
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State | CO
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Zip | 80226-1501
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Country | US
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Telephone | 303-936-5998
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Fax |
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Provider Business Mailing Address
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Address Line | 15 WADSWORTH BLVD
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City | LAKEWOOD
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State | CO
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Zip | 80226-1501
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Country | US
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Telephone | 303-936-5998
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM J. PONTARELLI JR.
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Credential | D.D.S.
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Telephone | 303-936-5998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 267
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License Number State | CO
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