Provider Demographics
NPI:1265073233
Name:COMMERCE CITY KIDS & FAMILY DENTAL, PLLC
Entity type:Organization
Organization Name:COMMERCE CITY KIDS & FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-252-9551
Mailing Address - Street 1:3825 PIERSON CT
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3983
Mailing Address - Country:US
Mailing Address - Phone:520-252-9551
Mailing Address - Fax:
Practice Address - Street 1:4972 E 62ND AVE UNIT B1
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-3253
Practice Address - Country:US
Practice Address - Phone:303-288-4969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty