MEDICARE: LODO DENTAL PC

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	332BC3200X	Customized Equipment (DME)
2	1223G0001X	General Practice Dentistry	8980	CO

General Provider Information

NPI Number	:	1255543393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LODO DENTAL PC

Provider Business Mailing Address
First Line	:	1435 WAZEE ST STE 102
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1491
Country	:	US
Telephone Number	:	303-623-5636
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 WAZEE ST STE 102
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1491
Country	:	US
Telephone Number	:	303-623-5636
Fax Number	:	303-623-5640

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLE KIKUE FURUTA GRIFFITH
Credential	:	DDS
Telephone Number	:	303-623-5636

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	04/28/2023

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Directions to “LODO DENTAL PC ” Practice Location

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