Organization
PEDIATRIC DENTAL GROUP OF WHEAT RIDGE
Active
Parent organization
PEDIATRIC DENTAL GROUP OF COLORADO
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEDIATRIC DENTAL GROUP OF COLORADO
Authorized official
KRISTEN BARDEN (PRACTICE MANAGER)
(303) 421-5437
Entity
Organization
Contact information
Practice address
3555 LUTHERAN PKWY, SUITE 310, WHEAT RIDGE, CO 80033-6021
(303) 467-8888
Mailing address
3555 LUTHERAN PKWY, SUITE 310, WHEAT RIDGE, CO 80033-6021
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
10389
CO
1223P0221X
Pediatric Dentistry
651
CO
1223P0221X
Pediatric Dentistry
Primary
7843
CO
1223P0221X
Pediatric Dentistry
8332
CO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
104928
CO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
104994
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02006518
—
CO
05
—
02078434
—
CO
05
—
38371847
—
CO
05
—
56483546
—
CO
05
—
64351084
—
CO
05
—
81227078
—
CO
Enumeration date
05/22/2017
Last updated
05/22/2017
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