Provider Demographics
NPI:1730506809
Name:DOWN TO EARTH DENTISTRY, LLC.
Entity type:Organization
Organization Name:DOWN TO EARTH DENTISTRY, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEFCIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-400-4560
Mailing Address - Street 1:17 W. 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050
Mailing Address - Country:US
Mailing Address - Phone:719-383-2083
Mailing Address - Fax:719-383-2047
Practice Address - Street 1:17 W. 4TH ST.
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050
Practice Address - Country:US
Practice Address - Phone:719-383-2083
Practice Address - Fax:719-383-2047
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOWN TO EARTH DENTISTRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-26
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00201897122300000X
CO002022981223G0001X
CO122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty