| Canyon Ridge Pediatric Dentistry | |
|
4344 Woodlands Blvd Suite 260 Castle Rock CO 80104-2801 | |
| (303) 841-7900 | |
| (303) 688-6210 |
| Full Name | Canyon Ridge Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 4344 Woodlands Blvd, Castle Rock, Colorado |
| Authorized Official Name and Position | Marc David Thomas (PEDIATRIC DENTIST) |
| Authorized Official Contact | 3038417900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Ridge Pediatric Dentistry 4344 Woodlands Blvd Suite 260 Castle Rock CO 80104-2801 Ph: (303) 841-7900 | Canyon Ridge Pediatric Dentistry 4344 Woodlands Blvd Suite 260 Castle Rock CO 80104-2801 Ph: (303) 841-7900 |
| NPI Number | 1447692538 |
|---|---|
| Provider Enumeration Date | 07/18/2013 |
| Last Update Date | 07/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447692538 | NPI | - | NPPES |
| 46455035 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 10771 (Colorado) | Primary |
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