Provider Demographics
NPI:1487255899
Name:CDK PEDO THORNTON, PLLC
Entity type:Organization
Organization Name:CDK PEDO THORNTON, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:COLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-277-5930
Mailing Address - Street 1:6870 S UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1515
Mailing Address - Country:US
Mailing Address - Phone:720-277-5930
Mailing Address - Fax:
Practice Address - Street 1:420 E 120TH AVE STE B11
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-1113
Practice Address - Country:US
Practice Address - Phone:720-453-3277
Practice Address - Fax:720-241-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000141734Medicaid