Provider Demographics
NPI:1538170527
Name:SOUTHEAST DENVER DENTAL ASSOCIATES PC
Entity type:Organization
Organization Name:SOUTHEAST DENVER DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-757-7175
Mailing Address - Street 1:2660 SOUTH MONACO PKWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222
Mailing Address - Country:US
Mailing Address - Phone:303-757-7175
Mailing Address - Fax:303-757-7179
Practice Address - Street 1:2660 SOUTH MONACO PKWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222
Practice Address - Country:US
Practice Address - Phone:303-757-7175
Practice Address - Fax:303-757-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO109316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty