Organization
TREASURED TEETH REUNION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERREN E TIPPETS DMD (OWNER)
(303) 853-9955
Entity
Organization
Contact information
Practice address
18335 E 103RD AVE UNIT 103, COMMERCE CITY, CO 80022-3103
(303) 853-9955
(303) 853-9954
Mailing address
18335 E 103RD AVE UNIT 103, COMMERCE CITY, CO 80022-3103
(303) 853-9955
(303) 853-9954
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
9579
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10179054
—
CO
05
—
77383877
—
CO
Enumeration date
03/03/2011
Last updated
03/07/2011
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