Provider Demographics
NPI:1770260820
Name:SANTISTEVAN, COURTNEY (DDS)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SANTISTEVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:BENNETT
Mailing Address - State:CO
Mailing Address - Zip Code:80102-8825
Mailing Address - Country:US
Mailing Address - Phone:303-644-5058
Mailing Address - Fax:
Practice Address - Street 1:250 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:BENNETT
Practice Address - State:CO
Practice Address - Zip Code:80102-8825
Practice Address - Country:US
Practice Address - Phone:303-644-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00205629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist