Provider Demographics
NPI:1528290939
Name:MOUNTAIN VIEW DENTAL LLC
Entity type:Organization
Organization Name:MOUNTAIN VIEW DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTISTS
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHANK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-768-8977
Mailing Address - Street 1:125 INVERNESS DR E
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5137
Mailing Address - Country:US
Mailing Address - Phone:303-768-8977
Mailing Address - Fax:303-649-9540
Practice Address - Street 1:125 INVERNESS DR E
Practice Address - Street 2:SUITE 310
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5137
Practice Address - Country:US
Practice Address - Phone:303-768-8977
Practice Address - Fax:303-649-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty