Provider Demographics
NPI:1619774528
Name:PEDIATRIC DENTAL GROUP OF EVERGREEN
Entity type:Organization
Organization Name:PEDIATRIC DENTAL GROUP OF EVERGREEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:STRANGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-588-7575
Mailing Address - Street 1:15053 W 55TH DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-2923
Mailing Address - Country:US
Mailing Address - Phone:303-421-5437
Mailing Address - Fax:303-422-5300
Practice Address - Street 1:30960 STAGECOACH BLVD STE W100
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7902
Practice Address - Country:US
Practice Address - Phone:303-670-7070
Practice Address - Fax:303-670-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty