Provider Demographics
NPI:1588382394
Name:CASTLE ROCK RESTORATIVE
Entity type:Organization
Organization Name:CASTLE ROCK RESTORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENINDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-659-1825
Mailing Address - Street 1:2700 E BRIDGE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2561
Mailing Address - Country:US
Mailing Address - Phone:303-659-1825
Mailing Address - Fax:720-821-0379
Practice Address - Street 1:1176 ALOHA ST STE 200A
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-2836
Practice Address - Country:US
Practice Address - Phone:720-703-4609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty