Provider Demographics
NPI:1992707954
Name:DENTAL ACCESS ADMINISTRATORS
Entity type:Organization
Organization Name:DENTAL ACCESS ADMINISTRATORS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJOR
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TAPPAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-394-0231
Mailing Address - Street 1:1717 YORK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1212
Mailing Address - Country:US
Mailing Address - Phone:303-394-0231
Mailing Address - Fax:303-329-4622
Practice Address - Street 1:1717 YORK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1212
Practice Address - Country:US
Practice Address - Phone:303-394-0231
Practice Address - Fax:303-329-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37836064Medicaid