Provider Demographics
NPI:1053199968
Name:EPIC DENTAL CARE PC
Entity type:Organization
Organization Name:EPIC DENTAL CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:VADIMOVNA
Authorized Official - Last Name:ROGOZHKINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-260-1389
Mailing Address - Street 1:2599 WADSWORTH BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5640
Mailing Address - Country:US
Mailing Address - Phone:303-421-4820
Mailing Address - Fax:
Practice Address - Street 1:2599 WADSWORTH BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5640
Practice Address - Country:US
Practice Address - Phone:303-421-4820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty