Healthcare Provider Details

I. General information

NPI: 1104273622
Provider Name (Legal Business Name): USMILE DENTAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 E COLFAX AVE
AURORA CO
80010-2154
US

IV. Provider business mailing address

9801 E COLFAX AVE
AURORA CO
80010-2154
US

V. Phone/Fax

Practice location:
  • Phone: 720-520-2053
  • Fax:
Mailing address:
  • Phone: 720-520-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00010381
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN.00010381
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00010381
License Number StateCO

VIII. Authorized Official

Name: MICHAEL SHIFMAN
Title or Position: CLINICAL DIRECTOR
Credential: DDS
Phone: 720-520-2053