MEDICARE: AAA FAMILY DENTAL CENTER II PC

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	122300000X	Dentist	HD104342	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1386660520	OTHER	CO	NATIONAL PROVIDER IDENTIF

General Provider Information

NPI Number	:	1659574978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AAA FAMILY DENTAL CENTER II PC

Provider Business Mailing Address
First Line	:	3805 NEWTON STREET
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211
Country	:	US
Telephone Number	:	303-455-0233
Fax Number	:	303-455-9251

Provider Business Practice Location Address
First Line	:	3805 NEWTON STREET
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211
Country	:	US
Telephone Number	:	303-455-0233
Fax Number	:	303-455-9251

Authorized Official
Title or Position	:	OWNER PRESIDENT AAA FAMILY DENTAL
Name	:	MR. GREGORY DEAN SCHLAGEL
Credential	:	DDS
Telephone Number	:	303-289-3358

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	08/22/2020

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