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850 W Happy Canyon Rd Castle Rock CO 80108-3908 | |
| (303) 688-6630 | |
| (303) 663-6534 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 850 W Happy Canyon Rd, Castle Rock, Colorado |
| Authorized Official Name and Position | Brenna Mclain (OWNER) |
| Authorized Official Contact | 3036886630 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3740 Dacoro Ln Ste 140 Castle Rock CO 80109-2504 Ph: (303) 688-6630 | 850 W Happy Canyon Rd Castle Rock CO 80108-3908 Ph: (303) 688-6630 |
| NPI Number | 1184385593 |
|---|---|
| Provider Enumeration Date | 01/07/2022 |
| Last Update Date | 01/04/2025 |
| Medicare PECOS PAC ID | 0143617704 |
|---|---|
| Medicare Enrollment ID | O20220428002146 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184385593 | NPI | - | NPPES |
| DEN.00203696 | Other | CO | CO DEPARTMENT OF REGULATORY AFFAIRS;DIV OF PROFESSIONS AND OCCUPATIONS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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