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General NPI Number Information
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NPI Number | 1942819362
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL DENTAL CARE OF CENTRAL COLORADO II,PLLC
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 7601 BURNING TREE DR STE 200
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City | FRANKTOWN
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State | CO
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Zip | 80116-9523
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Country | US
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Telephone | 303-688-2515
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Fax | 303-688-2589
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Provider Business Mailing Address
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Address Line | 10940 S PARKER RD # 121
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City | PARKER
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State | CO
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Zip | 80134-7440
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Country | US
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Telephone | 303-688-2515
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Fax | 303-688-2589
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Authorized Official
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Title or Position | OWNER
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Name | CARY LACOUTURE
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Credential | DDS
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Telephone | 303-688-2515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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