Provider Demographics
NPI:1174876288
Name:PERFECT TEETH / ERIE P.C
Entity type:Organization
Organization Name:PERFECT TEETH / ERIE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ARBUCKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-285-6098
Mailing Address - Street 1:3331 ARAPAHOE RD
Mailing Address - Street 2:UNIT 30
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6007
Mailing Address - Country:US
Mailing Address - Phone:303-828-2500
Mailing Address - Fax:303-828-2900
Practice Address - Street 1:3331 ARAPAHOE RD
Practice Address - Street 2:UNIT 30
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-6007
Practice Address - Country:US
Practice Address - Phone:303-828-2500
Practice Address - Fax:303-828-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty