Provider Demographics
NPI:1871902171
Name:RICHARD J. ITO, DDS, PC
Entity type:Organization
Organization Name:RICHARD J. ITO, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ITO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-296-1825
Mailing Address - Street 1:1905 LAWRENCE ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1826
Mailing Address - Country:US
Mailing Address - Phone:303-296-1825
Mailing Address - Fax:303-296-1825
Practice Address - Street 1:1905 LAWRENCE ST UNIT A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1826
Practice Address - Country:US
Practice Address - Phone:303-296-1825
Practice Address - Fax:303-296-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1041351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty