Provider Demographics
NPI:1003189127
Name:DOUGLAS COUNTY ORTHODONTICS
Entity type:Organization
Organization Name:DOUGLAS COUNTY ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HAMERSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:720-344-2662
Mailing Address - Street 1:9362 S COLORADO BLVD
Mailing Address - Street 2:SUITE D14
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-5201
Mailing Address - Country:US
Mailing Address - Phone:720-344-2662
Mailing Address - Fax:720-344-2663
Practice Address - Street 1:9362 S COLORADO BLVD
Practice Address - Street 2:SUITE D14
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-5201
Practice Address - Country:US
Practice Address - Phone:720-344-2662
Practice Address - Fax:720-344-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty