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PEDO THREE PROF. LLC NPI 1114166857


NPI Information

NPI: 1114166857
Provider Name: PEDO THREE, PROF. LLC

Doing Business As: GRIN PEDIATRIC DENTISTRY & ORTHODONTICS OF CENTENNIAL

Classification: Dentist - 1223P0221X
Entity Type: Organization

Specialization: Pediatric Dentistry

Address:
6870 S UNIVERSITY BLVD
CENTENNIAL, CO
ZIP 80122
Phone: (720) 277-5930
Get Directions

PEDO THREE, PROF. LLC is a pediatric dentistry dentist in Centennial, CO. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. PEDO THREE, PROF. LLC NPI is 1114166857. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Grin Pediatric Dentistry & Orthodontics Of Centennial.

The provider's business location address is:

6870 S UNIVERSITY BLVD
CENTENNIAL, CO
ZIP 80122-515
Phone: (720) 277-5930
Fax: (720) 241-7811

The provider's authorized official is Colton Flake .
The authorized official title is President and has the following contact phone number (720) 277-5930.

The enumeration date for this NPI number is 2/18/2009 and was last updated on 9/12/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1122300000XDentist10630COLORADONo
21223P0221XDentistPediatric Dentistry10630COLORADONo
31223P0221XDentistPediatric DentistryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
144075871MEDICAIDCOLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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