Provider Demographics
NPI:1053566885
Name:BATTLEMENT CREEK DENTAL CENTER, PLLC
Entity type:Organization
Organization Name:BATTLEMENT CREEK DENTAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARI
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARCOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-241-4800
Mailing Address - Street 1:73 SIPPRELLE DR STE M
Mailing Address - Street 2:
Mailing Address - City:PARACHUTE
Mailing Address - State:CO
Mailing Address - Zip Code:81635-9213
Mailing Address - Country:US
Mailing Address - Phone:970-285-9004
Mailing Address - Fax:
Practice Address - Street 1:73 SIPPRELLE DR STE M
Practice Address - Street 2:
Practice Address - City:PARACHUTE
Practice Address - State:CO
Practice Address - Zip Code:81635-9213
Practice Address - Country:US
Practice Address - Phone:970-285-9004
Practice Address - Fax:970-285-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty