Organization
PATRA WATANA DMD PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRA WATANA (OWNER)
(303) 740-7088
Entity
Organization
Contact information
Practice address
8200 E. BELLEVIEW AVE., SUITE #420E, GREENWOOD VILLAGE, CO 80111
(303) 740-7088
Mailing address
8200 E BELLEVIEW AVE, SUITE #420E, GREENWOOD VILLAGE, CO 80111-2803
(303) 740-7088
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
6614
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02123371
—
CO
Enumeration date
07/03/2014
Last updated
07/03/2014
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