Provider Demographics
NPI:1366048076
Name:A KIDZ DENTIST
Entity type:Organization
Organization Name:A KIDZ DENTIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:HANK
Authorized Official - Last Name:SALYER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-879-7976
Mailing Address - Street 1:1560 PINE GROVE RD STE C
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8004
Mailing Address - Country:US
Mailing Address - Phone:970-879-7976
Mailing Address - Fax:
Practice Address - Street 1:1560 PINE GROVE RD STE C
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8004
Practice Address - Country:US
Practice Address - Phone:970-879-7976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A KIDZ DENTIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7535OtherCOLORADO DENTAL LICENSE
CO44533063Medicaid
CO54838576Medicaid