Basic Information
| Provider Information | |||||||||
| NPI: | 1174876288 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERFECT TEETH / ERIE P.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3331 ARAPAHOE RD | ||||||||
| Address2: | UNIT 30 | ||||||||
| City: | ERIE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805166007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038282500 | ||||||||
| FaxNumber: | 3038282900 | ||||||||
| Practice Location | |||||||||
| Address1: | 3331 ARAPAHOE RD | ||||||||
| Address2: | UNIT 30 | ||||||||
| City: | ERIE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805166007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038282500 | ||||||||
| FaxNumber: | 3038282900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2012 | ||||||||
| LastUpdateDate: | 10/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | ARBUCKLE | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3032856098 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 6097 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.