Perfect Teeth - East 104th Avenue P.c.

NPI #1922128859 in Thornton, Colorado

Provider Information

NPI Number: 1922128859
Entity Type: Organization
Organization Name: Perfect Teeth - East 104th Avenue P.c.
Primary Specialty: Dentist - General Practice
Enumeration Date: Apr 2, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 2200 E 104TH AVE
Address 2: #112
City: Thornton
State: Colorado
ZIP Code: 80233-4404
Phone: (303) 452-4142

Authorized Official

Name: LAURIE SUMMERS
Title: CREDENTIALING
Phone: (303) 285-6098

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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