Provider Demographics
NPI:1386489565
Name:ROCKY MOUNTAIN DENTAL SPECIALISTS
Entity type:Organization
Organization Name:ROCKY MOUNTAIN DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-293-9194
Mailing Address - Street 1:1551 PROFESSIONAL LN UNIT 250
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6967
Mailing Address - Country:US
Mailing Address - Phone:270-293-9194
Mailing Address - Fax:
Practice Address - Street 1:1551 PROFESSIONAL LN UNIT 250
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6967
Practice Address - Country:US
Practice Address - Phone:270-293-9194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty