Provider Demographics
NPI:1730904715
Name:CARBON VALLEY DENTAL COMPANY LLC
Entity type:Organization
Organization Name:CARBON VALLEY DENTAL COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-845-7601
Mailing Address - Street 1:12801 LAFAYETTE ST UNIT D202
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-1810
Mailing Address - Country:US
Mailing Address - Phone:210-845-7601
Mailing Address - Fax:
Practice Address - Street 1:8350 COLORADO BLVD UNIT 150
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6803
Practice Address - Country:US
Practice Address - Phone:210-845-7601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental