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General NPI Number Information
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NPI Number | 1790806487
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Entity Type | Organization
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Legal Business Name | PERFECT TEETH - GREEN MOUNTAIN P.C.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13035 W ALAMEDA PKWY
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City | LAKEWOOD
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State | CO
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Zip | 80228-3107
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Country | US
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Telephone | 303-987-0544
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Fax | 303-914-9883
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Provider Business Mailing Address
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Address Line | 13035 W ALAMEDA PKWY
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City | LAKEWOOD
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State | CO
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Zip | 80228-3107
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Country | US
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Telephone | 303-987-0544
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Fax | 303-914-9883
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Authorized Official
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Title or Position | CREDENTIALING
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Name | LAURIE SUMMERS
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Credential |
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Telephone | 303-285-6098
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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 | 6097
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License Number State | CO
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