Provider Demographics
NPI:1972711372
Name:OFFERDAHL, JOHN GILBERT (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GILBERT
Last Name:OFFERDAHL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2598 S LEWIS WAY
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2292
Mailing Address - Country:US
Mailing Address - Phone:303-987-9109
Mailing Address - Fax:303-987-9123
Practice Address - Street 1:2598 S LEWIS WAY
Practice Address - Street 2:SUITE 3C
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-2292
Practice Address - Country:US
Practice Address - Phone:303-987-9109
Practice Address - Fax:303-987-9123
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO1049171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice