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General NPI Number Information
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NPI Number | 1811855059
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Entity Type | Organization
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Legal Business Name | LAKEWOOD PDC PLLC
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 2535 S LEWIS WAY STE 105
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City | LAKEWOOD
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State | CO
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Zip | 80227-6558
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Country | US
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Telephone | 303-936-5644
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Fax | 303-936-0119
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Provider Business Mailing Address
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Address Line | 727 E UTAH VALLEY DR
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City | AMERICAN FORK
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State | UT
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Zip | 84003-3345
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MARK CHRISTENSEN
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Credential |
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Telephone | 801-305-3460
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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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