Provider Demographics
NPI:1215303854
Name:LONE TREE PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:LONE TREE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-793-0899
Mailing Address - Street 1:10450 PARK MEADOWS DR
Mailing Address - Street 2:#308
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5529
Mailing Address - Country:US
Mailing Address - Phone:303-793-0899
Mailing Address - Fax:303-793-0895
Practice Address - Street 1:10450 PARK MEADOWS DR
Practice Address - Street 2:#308
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5529
Practice Address - Country:US
Practice Address - Phone:303-793-0899
Practice Address - Fax:303-793-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty