MEDICARE: HOWARD DENTAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	DEN10544	CO

General Provider Information

NPI Number	:	1225298920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOWARD DENTAL CENTER

Provider Business Mailing Address
First Line	:	1420 OGDEN STREET
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-2892
Country	:	US
Telephone Number	:	303-863-0772
Fax Number	:	303-832-7823

Provider Business Practice Location Address
First Line	:	1420 OGDEN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-2892
Country	:	US
Telephone Number	:	303-863-0772
Fax Number	:	303-832-7823

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. FELICIA L DIAMOND
Credential	:
Telephone Number	:	303-863-0772

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	06/16/2008

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