Provider Demographics
NPI:1962886010
Name:EAST ARAPAHOE DENTAL CARE
Entity type:Organization
Organization Name:EAST ARAPAHOE DENTAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-766-4444
Mailing Address - Street 1:14555 E ARAPAHOE RD UNIT D
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1584
Mailing Address - Country:US
Mailing Address - Phone:303-766-4444
Mailing Address - Fax:303-862-3695
Practice Address - Street 1:14555 E ARAPAHOE RD UNIT D
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1584
Practice Address - Country:US
Practice Address - Phone:303-766-4444
Practice Address - Fax:303-862-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty