Provider Demographics
NPI:1871992404
Name:EGERT-KREIDER DENTAL
Entity type:Organization
Organization Name:EGERT-KREIDER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:EGERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-744-3636
Mailing Address - Street 1:3955 E. EXPOSTITION AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209
Mailing Address - Country:US
Mailing Address - Phone:303-744-3636
Mailing Address - Fax:303-744-3724
Practice Address - Street 1:3955 E. EXPOSTITION AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209
Practice Address - Country:US
Practice Address - Phone:303-744-3636
Practice Address - Fax:303-744-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty