MEDICARE: KIDS IN NEED OF DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1205435013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS IN NEED OF DENTISTRY

Provider Business Mailing Address
First Line	:	7190 COLORADO BLVD STE 300
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-1808
Country	:	US
Telephone Number	:	303-733-3710
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 E 72ND AVE UNIT D
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-1578
Country	:	US
Telephone Number	:	720-619-5333
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ELLIE BURBEE
Credential	:
Telephone Number	:	720-795-9791

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	01/14/2022

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