Provider Demographics
NPI:1992292676
Name:STAFFEN, ADAM MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MATTHEW
Last Name:STAFFEN
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 1:4472 YATES ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2427
Mailing Address - Country:US
Mailing Address - Phone:703-795-8145
Mailing Address - Fax:
Practice Address - Street 1:7015 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4876
Practice Address - Country:US
Practice Address - Phone:303-940-9755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002040421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice