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12297 Pennsylvania St Suite 2 Thornton CO 80241-3165 | |
| (303) 920-4196 | |
| (303) 920-4198 |
| Full Name | |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 12297 Pennsylvania St, Thornton, Colorado |
| Authorized Official Name and Position | Matthew S Davis (PRESIDENT/OWNER) |
| Authorized Official Contact | 3039204196 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12297 Pennsylvania St Suite 2 Thornton CO 80241-3165 Ph: (303) 920-4196 | 12297 Pennsylvania St Suite 2 Thornton CO 80241-3165 Ph: (303) 920-4196 |
| NPI Number | 1598859662 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598859662 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 6963 (Colorado) | Primary |
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