| Kids Tooth Doc | |
|
5168 S Broadway Englewood CO 80113-6706 | |
| (303) 974-5868 | |
| Not Available |
| Full Name | Kids Tooth Doc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 5168 S Broadway, Englewood, Colorado |
| Authorized Official Name and Position | Brian Fox (MANAGER) |
| Authorized Official Contact | 3039477705 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kids Tooth Doc 5168 S Broadway Englewood CO 80113-6706 Ph: (303) 974-5868 | Kids Tooth Doc 5168 S Broadway Englewood CO 80113-6706 Ph: (303) 974-5868 |
| NPI Number | 1689012122 |
|---|---|
| Provider Enumeration Date | 06/06/2013 |
| Last Update Date | 12/27/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689012122 | NPI | - | NPPES |
| 92133312 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (Colorado) | Primary |
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