Provider Demographics
NPI:1992929939
Name:ARMSTRONG, JACK CRAIG (DDS)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:CRAIG
Last Name:ARMSTRONG
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 1:1040 S GAYLORD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4652
Mailing Address - Country:US
Mailing Address - Phone:303-777-6202
Mailing Address - Fax:303-777-0432
Practice Address - Street 1:1040 S GAYLORD ST STE 103
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4652
Practice Address - Country:US
Practice Address - Phone:303-777-6202
Practice Address - Fax:303-777-0432
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1046581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice