Provider Demographics
NPI:1770949927
Name:EXCELLENCE IN DENTISTRY OF GREELEY PLLC
Entity type:Organization
Organization Name:EXCELLENCE IN DENTISTRY OF GREELEY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-353-4329
Mailing Address - Street 1:1600 23RD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6070
Mailing Address - Country:US
Mailing Address - Phone:970-353-4329
Mailing Address - Fax:970-353-0526
Practice Address - Street 1:1600 23RD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6070
Practice Address - Country:US
Practice Address - Phone:970-353-4329
Practice Address - Fax:970-353-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty