Healthcare Provider Details

I. General information

NPI: 1013872704
Provider Name (Legal Business Name): ALEXANDER WALTER IRICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 E COLFAX AVE
AURORA CO
80010-2371
US

IV. Provider business mailing address

4502 IRVING ST
DENVER CO
80211-1346
US

V. Phone/Fax

Practice location:
  • Phone: 303-344-2273
  • Fax:
Mailing address:
  • Phone: 303-344-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00206465
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: