Provider Demographics
NPI:1285895698
Name:LAMAR DENTAL ASSOCIATES
Entity type:Organization
Organization Name:LAMAR DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CASEY
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-336-9023
Mailing Address - Street 1:110 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-2708
Mailing Address - Country:US
Mailing Address - Phone:719-336-9023
Mailing Address - Fax:719-336-9064
Practice Address - Street 1:110 S 5TH ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2708
Practice Address - Country:US
Practice Address - Phone:719-336-9023
Practice Address - Fax:719-336-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO05441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty