| Treasured Teeth Reunion | |
|
18335 E 103rd Ave Unit 103 Commerce City CO 80022-3103 | |
| (303) 853-9955 | |
| (303) 853-9954 |
| Full Name | Treasured Teeth Reunion |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 18335 E 103rd Ave Unit 103, Commerce City, Colorado |
| Authorized Official Name and Position | Derren E Tippets (OWNER) |
| Authorized Official Contact | 3038539955 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Treasured Teeth Reunion 18335 E 103rd Ave Unit 103 Commerce City CO 80022-3103 Ph: (303) 853-9955 | Treasured Teeth Reunion 18335 E 103rd Ave Unit 103 Commerce City CO 80022-3103 Ph: (303) 853-9955 |
| NPI Number | 1497053284 |
|---|---|
| Provider Enumeration Date | 03/03/2011 |
| Last Update Date | 03/07/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497053284 | NPI | - | NPPES |
| 77383877 | Medicaid | CO | |
| 10179054 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 9579 (Colorado) | Primary |
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