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NPI Code Detail

MEDICARE: KIDS CHOICE DENTAL OF AURORA PC

MEDICARE: KIDS CHOICE DENTAL OF AURORA 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
11223G0001XGeneral Practice Dentistry8151CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770755381
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDS CHOICE DENTAL OF AURORA PC
Provider Business Mailing Address
First Line : 15159 E COLFAX AVE UNIT B
Second Line :
City : AURORA
State : CO
Zip : 80011-5707
Country : US
Telephone Number : 303-341-5437
Fax Number : 303-341-5447
Provider Business Practice Location Address
First Line : 15159 E COLFAX AVE UNIT B
Second Line :
City : AURORA
State : CO
Zip : 80011-5707
Country : US
Telephone Number : 303-341-5437
Fax Number : 303-341-5447
Authorized Official
Title or Position : OWNER
Name : DR. DAVOOD MANSHADI
Credential : DDS
Telephone Number : 303-341-5437
Provider Enumeration Date : 03/24/2008
Last Update Date : 03/24/2008

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15159 E COLFAX AVE UNIT B
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Practice Fax: 303-341-6447
1225225071 — DR. MARGARITA MONICA LACHICA DDS, MS
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80011-5707
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Practice Fax: 719-542-0425
1992235410 — DR. FARAH HAGMAN DDS
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15159 E COLFAX AVE UNIT B
AURORA, CO
80011-5707
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1548887532 — MINH N TRINH
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1588265813 — BRIGHT EYES VISION CLINIC PC A COLORADO PROFESSIONAL CORPORATION
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Directions to “KIDS CHOICE DENTAL OF AURORA PC ” Practice Location

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