Provider Demographics
NPI:1346842283
Name:THE DENVER DENTISTS
Entity type:Organization
Organization Name:THE DENVER DENTISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-731-2005
Mailing Address - Street 1:2190 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1126
Mailing Address - Country:US
Mailing Address - Phone:303-731-2005
Mailing Address - Fax:
Practice Address - Street 1:2190 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1126
Practice Address - Country:US
Practice Address - Phone:303-731-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DENVER DENTISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000153400Medicaid