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General NPI Number Information
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NPI Number | 1740433762
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Entity Type | Organization
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Legal Business Name | CRESTLINE DENTAL GROUP AND ORTHODONTICS, LLP
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 5392 S WADSWORTH BLVD UNIT 103
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City | LAKEWOOD
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State | CO
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Zip | 80123-2227
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Country | US
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Telephone | 303-979-4227
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Fax | 303-845-5120
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Provider Business Mailing Address
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Address Line | 2860 MICHELLE 2ND FLOOR
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City | IRVINE
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State | CA
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Zip | 92606-1009
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Country | US
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Telephone | 714-368-2077
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Fax | 714-368-2092
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. CHARLES F RODGERS
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Credential | DDS
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Telephone | 303-979-4227
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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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