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General NPI Number Information
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NPI Number | 1871902171
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Entity Type | Organization
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Legal Business Name | RICHARD J. ITO, DDS, PC
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 1905 LAWRENCE ST UNIT A
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City | DENVER
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State | CO
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Zip | 80202-1826
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Country | US
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Telephone | 303-296-1825
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Fax | 303-296-1825
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Provider Business Mailing Address
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Address Line | 1905 LAWRENCE ST UNIT A
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City | DENVER
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State | CO
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Zip | 80202-1826
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Country | US
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Telephone | 303-296-1825
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Fax | 303-296-1825
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | RICHARD J ITO
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Credential | DDS
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Telephone | 303-296-1825
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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 | 104135
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License Number State | CO
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