Provider Demographics
NPI:1730244740
Name:KIDS IN NEED OF DENTISTRY
Entity type:Organization
Organization Name:KIDS IN NEED OF DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-795-9791
Mailing Address - Street 1:7190 COLORADO BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-1808
Mailing Address - Country:US
Mailing Address - Phone:303-733-3710
Mailing Address - Fax:
Practice Address - Street 1:7190 COLORADO BLVD STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80022-1808
Practice Address - Country:US
Practice Address - Phone:303-733-3710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
124Q00000X, 1223G0001X
CO201198124Q00000X, 124Q00000X
CO201877124Q00000X, 124Q00000X
CO87811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29655561Medicaid
CO30086779Medicaid
CO34959076Medicaid
CO63480565Medicaid
CO26277581Medicaid
CO02000701Medicaid
CO21823839Medicaid
CO02001618Medicaid
CO29655561Medicaid