Provider Demographics
NPI:1104127695
Name:UNIVERSITY OF COLORADO SCHOOL OF DENTAL MEDICINE
Entity type:Organization
Organization Name:UNIVERSITY OF COLORADO SCHOOL OF DENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN OF ACADEMIC AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLUENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-724-7124
Mailing Address - Street 1:13065 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2532
Mailing Address - Country:US
Mailing Address - Phone:303-724-7044
Mailing Address - Fax:303-724-6999
Practice Address - Street 1:13065 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2532
Practice Address - Country:US
Practice Address - Phone:303-724-7044
Practice Address - Fax:303-724-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO200936261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental