NPIMap

Organization Active NPI

Pedo Three Prof. LLC

  • Pediatric Dentistry
  • Thornton, CO
National Provider Identifier
1487190393
Registry record updated Jan 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
10630 Issued in CO
Legal business name
PEDO THREE PROF. LLC
Doing business as
Comfort Kids - Thornton
Practice address
9652 Washington St
Thornton, CO 80229-2160
Phone
(720) 277-5930
Fax
(877) 444-4055
NPI assigned
Jan 17, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2017

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

Authorized official

Name
Dr. Colton Flake, D.D.S.
Title
Owner
Phone
(720) 277-5930

Specialties & licenses 2

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

Addresses

Primary practice location

9652 Washington St
Thornton, CO 80229-2160

Mailing address

8223 S Quebec St
Suite O
Centennial, CO 80112-4415

Other identifiers 1

IdentifierTypeStateIssuer
44075871MedicaidCO

Other names 1

  • Comfort Kids - Thornton 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.

NPI Registry JSON

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

{
    "created_epoch": "1484611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484611200000",
    "number": "1487190393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8223 S QUEBEC ST",
            "address_2": "SUITE O",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801124415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9652 WASHINGTON ST",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802292160",
            "telephone_number": "720-277-5930",
            "fax_number": "877-444-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDO THREE PROF. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-17",
        "last_updated": "2017-01-17",
        "status": "A",
        "authorized_official_last_name": "FLAKE",
        "authorized_official_first_name": "COLTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-277-5930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "10630",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "10630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44075871",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comfort Kids - Thornton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thornton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2017; 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.