Provider Demographics
NPI:1548846504
Name:SPROUT AND BLOOM PEDIATRIC DENTISTRY, PLLC
Entity type:Organization
Organization Name:SPROUT AND BLOOM PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-615-6087
Mailing Address - Street 1:13402 W COAL MINE AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-5407
Mailing Address - Country:US
Mailing Address - Phone:720-615-6087
Mailing Address - Fax:720-615-6086
Practice Address - Street 1:13402 W COAL MINE AVE STE 125
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-5407
Practice Address - Country:US
Practice Address - Phone:720-615-6087
Practice Address - Fax:720-615-6086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-21
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty