Provider Demographics
NPI:1871973776
Name:BITTERSWEET PROF.LLC
Entity type:Organization
Organization Name:BITTERSWEET PROF.LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREEA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOROK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-244-7172
Mailing Address - Street 1:1540 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3978
Mailing Address - Country:US
Mailing Address - Phone:303-757-5885
Mailing Address - Fax:
Practice Address - Street 1:1540 S HOLLY ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3978
Practice Address - Country:US
Practice Address - Phone:303-757-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BITTERSWEET PROF.LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9926261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental