Provider Demographics
NPI:1396284055
Name:ROWE AND BALTZ DENTAL, PLLC
Entity type:Organization
Organization Name:ROWE AND BALTZ DENTAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-206-3968
Mailing Address - Street 1:3574 S TOWER RD
Mailing Address - Street 2:STE B
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-3561
Mailing Address - Country:US
Mailing Address - Phone:303-617-9100
Mailing Address - Fax:303-617-9198
Practice Address - Street 1:3574 S TOWER RD
Practice Address - Street 2:STE B
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-3561
Practice Address - Country:US
Practice Address - Phone:303-617-9100
Practice Address - Fax:303-617-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1050061223G0001X
CO104221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1922464122OtherINDIVIDUAL NPI NUMBER
CO1902125578OtherINDIVIDUAL NPI NUMBER