Provider Demographics
NPI:1023153673
Name:COLORADO DHCA , DTC, PLLC
Entity type:Organization
Organization Name:COLORADO DHCA , DTC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-779-8587
Mailing Address - Street 1:5031 S ULSTER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2806
Mailing Address - Country:US
Mailing Address - Phone:303-779-8587
Mailing Address - Fax:303-779-9182
Practice Address - Street 1:5031 S ULSTER ST STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2806
Practice Address - Country:US
Practice Address - Phone:303-779-8587
Practice Address - Fax:303-779-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841525799OtherSPECIALTY