Healthcare Provider Details

I. General information

NPI: 1467688291
Provider Name (Legal Business Name): PEDIATRIC DENTAL GROUP OF ARVADA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 ALLISON WAY
ARVADA CO
80005-4428
US

IV. Provider business mailing address

7975 ALLISON WAY
ARVADA CO
80005-4428
US

V. Phone/Fax

Practice location:
  • Phone: 303-421-5437
  • Fax: 303-422-5300
Mailing address:
  • Phone: 303-421-5437
  • Fax: 303-422-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7843
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6365
License Number StateCO

VIII. Authorized Official

Name: DR. DAVID MALCOLM STRANGE JR.
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 303-467-8888