Provider Demographics
NPI: | 1386765774 |
---|---|
Name: | PERFECT TEETH - SPEER P.C. |
Entity type: | Organization |
Organization Name: | PERFECT TEETH - SPEER P.C. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | RCM, DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LAUREN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HILL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 972-930-7707 |
Mailing Address - Street 1: | 700 E SPEER BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | DENVER |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80203-4256 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-733-1010 |
Mailing Address - Fax: | 303-733-2451 |
Practice Address - Street 1: | 700 E SPEER BLVD |
Practice Address - Street 2: | |
Practice Address - City: | DENVER |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80203-4256 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-733-1010 |
Practice Address - Fax: | 303-733-2451 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-03 |
Last Update Date: | 2022-09-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 6097 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |