Healthcare Provider Details

I. General information

NPI: 1831010495
Provider Name (Legal Business Name): FORMOSA DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15389 W 91ST DR STE 201
ARVADA CO
80007-1405
US

IV. Provider business mailing address

5850 CENTRAL AVE UNIT 523
WESTMINSTER CO
80031-2984
US

V. Phone/Fax

Practice location:
  • Phone: 720-608-3988
  • Fax: 720-608-8078
Mailing address:
  • Phone: 720-608-3988
  • Fax: 720-608-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEREMY CHEN
Title or Position: PARTNER
Credential: DDS
Phone: 720-608-3988