Provider Demographics
NPI:1215428602
Name:ARENS, DYLAN JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:JOSEPH
Last Name:ARENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 ZACHARY GRV APT V108
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-6516
Mailing Address - Country:US
Mailing Address - Phone:402-649-3397
Mailing Address - Fax:
Practice Address - Street 1:550 SAINT MICHAELS DR # 2
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7604
Practice Address - Country:US
Practice Address - Phone:505-471-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204138122300000X
NMDD48811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice