Provider Demographics
NPI:1578000105
Name:GOERGEN, LACEY E (DDS)
Entity type:Individual
Prefix:DR
First Name:LACEY
Middle Name:E
Last Name:GOERGEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 EAST CHERRY CREEK DRIVE SOUTH
Mailing Address - Street 2:SUITE 840
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246
Mailing Address - Country:US
Mailing Address - Phone:303-377-1148
Mailing Address - Fax:
Practice Address - Street 1:4500 CHERRY CREEK DRIVE SOUTH
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246
Practice Address - Country:US
Practice Address - Phone:303-377-1148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2031011223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry