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General NPI Number Information
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NPI Number | 1952549636
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Entity Type | Organization
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Legal Business Name | THE LIONS TOOTH, LLC
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 630 MAIN STREET UNIT B
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City | FREDERICK
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State | CO
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Zip | 80530
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Country | US
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Telephone | 303-833-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 2146 REDFIELD CIR
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City | LONGMONT
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State | CO
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Zip | 80501-9810
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Country | US
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Telephone | 303-833-5500
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Fax | 866-514-8749
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. RICHARD A SHULZE
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Credential | D.M.D
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Telephone | 303-833-5500
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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 | 9053
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License Number State | CO
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