Provider Demographics
NPI:1871163840
Name:SIMKO PEDIATRIC DENTISTRY OF COLORADO, PC
Entity type:Organization
Organization Name:SIMKO PEDIATRIC DENTISTRY OF COLORADO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-205-0755
Mailing Address - Street 1:3902 OAKWOOD HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7780
Mailing Address - Country:US
Mailing Address - Phone:715-205-0755
Mailing Address - Fax:
Practice Address - Street 1:6850 E HAMPDEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3024
Practice Address - Country:US
Practice Address - Phone:303-758-6057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMKO PEDIATRIC DENTISTRY OF COLORADO, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty