Provider Demographics
NPI:1306336318
Name:KIDS MILE HIGH PEDIATRIC DENTISTRY AND ORTHODONTICS, PLLC
Entity type:Organization
Organization Name:KIDS MILE HIGH PEDIATRIC DENTISTRY AND ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-744-1701
Mailing Address - Street 1:1780 S BELLAIRE ST STE 345
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4355
Mailing Address - Country:US
Mailing Address - Phone:303-744-1701
Mailing Address - Fax:
Practice Address - Street 1:125 INVERNESS DR E STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5139
Practice Address - Country:US
Practice Address - Phone:303-779-5306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO85381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty