Basic Information
Provider Information
NPI: 1083192983
EntityType: 2
ReplacementNPI:  
OrganizationName: WHEAT RIDGE DENTISTS, LLP
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: WHEAT RIDGE DENTISTS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 17000 RED HILL AVE
Address2:  
City: IRVINE
State: CA
PostalCode: 926145626
CountryCode: US
TelephoneNumber: 7148458890
FaxNumber: 3039520892
Practice Location
Address1: 3727 WADSWORTH BLVD STE 122
Address2:  
City: WHEAT RIDGE
State: CO
PostalCode: 800334661
CountryCode: US
TelephoneNumber: 3035361967
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/02/2018
LastUpdateDate: 08/02/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WESTPHAL
AuthorizedOfficialFirstName: ERIK
AuthorizedOfficialMiddleName: C
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 3035361967
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DDS
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X  Y193200000X MULTI-SPECIALTY GROUPDental ProvidersDentist 

No ID Information.


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