Basic Information
| Provider Information | |||||||||
| NPI: | 1003189127 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOUGLAS COUNTY ORTHODONTICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9362 S COLORADO BLVD | ||||||||
| Address2: | SUITE D14 | ||||||||
| City: | HIGHLANDS RANCH | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801265201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203442662 | ||||||||
| FaxNumber: | 7203442663 | ||||||||
| Practice Location | |||||||||
| Address1: | 9362 S COLORADO BLVD | ||||||||
| Address2: | SUITE D14 | ||||||||
| City: | HIGHLANDS RANCH | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801265201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203442662 | ||||||||
| FaxNumber: | 7203442663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2012 | ||||||||
| LastUpdateDate: | 02/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | HAMERSKY | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | ALAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7203442662 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS, MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 4397 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.