=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942159660
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDODONTICS OF CASTLE ROCK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2026
-----------------------------------------------------
Last Update Date | 01/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4344 WOODLANDS BLVD
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80104-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-328-3979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4344 WOODLANDS BLVD
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80104-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-328-3979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ENDODONTIST
-----------------------------------------------------
Name | BROCK DEAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-328-3979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------