Provider Demographics
NPI:1538889027
Name:PLAZA DENTAL PARKER PLLC
Entity type:Organization
Organization Name:PLAZA DENTAL PARKER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-917-8019
Mailing Address - Street 1:6450 S DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121-2518
Mailing Address - Country:US
Mailing Address - Phone:708-917-8019
Mailing Address - Fax:
Practice Address - Street 1:10470 S PROGRESS WAY UNIT 100
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4037
Practice Address - Country:US
Practice Address - Phone:720-870-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental