NPIMap

Organization Active NPI

Pedo Two, Prof. LLC

  • Pediatric Dentistry
  • Lakewood, CO
National Provider Identifier
1114166865
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
PEDO TWO, PROF. LLC
Doing business as
Comfort Dental Kids - Lakewood
Comfort Dental Kids West
GRiN Pediatric Dentistry & Orthodontics
Practice address
7475 W Colfax Ave Ste 103
Lakewood, CO 80214-5425
Phone
(720) 512-2879
Fax
(720) 241-7811
NPI assigned
Feb 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Colton Flake, DDSNPI 1578879417
Title
President
Phone
(720) 277-5930

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 10630 CO
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 10630 CO
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

7475 W Colfax Ave Ste 103
Lakewood, CO 80214-5425

Mailing address

6870 S University Blvd
Centennial, CO 80122-1515
Phone (720) 512-5879

Other identifiers 1

IdentifierTypeStateIssuer
01928376MedicaidCO

Other names 3

  • Comfort Dental Kids - Lakewood Doing business as
  • Comfort Dental Kids West Doing business as
  • GRiN Pediatric Dentistry & Orthodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Comfort Dental Kids - Aurora4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7475 W Colfax Ave
Ste 103
Lakewood, CO 80214
Phone (720) 512-2879

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1114166865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6870 S UNIVERSITY BLVD",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801221515",
            "telephone_number": "720-512-5879",
            "fax_number": "720-241-7811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7475 W COLFAX AVE STE 103",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802145425",
            "telephone_number": "720-512-2879",
            "fax_number": "720-241-7811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDO TWO, PROF. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-19",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A",
        "authorized_official_last_name": "FLAKE",
        "authorized_official_first_name": "COLTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "720-277-5930",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "10630",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "10630",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01928376",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comfort Dental Kids - Lakewood",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Comfort Dental Kids - Lakewood",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Comfort Dental Kids West",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GRiN Pediatric Dentistry & Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.