Organization
PEDIATRIC DENTAL GROUP OF LAKEWOOD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE E HARTSHORN (OFFICE MANAGER)
(720) 338-9778
Entity
Organization
Contact information
Practice address
3333 S WADSWORTH BLVD UNIT B104, LAKEWOOD, CO 80227-5120
(303) 984-9700
(303) 985-2490
Mailing address
3333 S WADSWORTH BLVD UNIT B102B104, LAKEWOOD, CO 80227-5122
(303) 984-9700
(303) 985-2490
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02006518
—
CO
05
—
02078434
—
CO
05
—
38371847
—
CO
05
—
44332866
—
CO
05
—
83777709
—
CO
Enumeration date
06/05/2009
Last updated
06/22/2020
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