Provider Demographics
NPI:1487700126
Name:TOOTHZONE, L.L.C
Entity type:Organization
Organization Name:TOOTHZONE, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-223-8687
Mailing Address - Street 1:3636 ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:CO
Mailing Address - Zip Code:80535-9319
Mailing Address - Country:US
Mailing Address - Phone:970-493-3799
Mailing Address - Fax:
Practice Address - Street 1:1220 OAK PARK DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7302
Practice Address - Country:US
Practice Address - Phone:970-223-8687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04019725Medicaid