Healthcare Provider Details

I. General information

NPI: 1861464018
Provider Name (Legal Business Name): ERIC L MACK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S CHAMBERS RD
AURORA CO
80014-4503
US

IV. Provider business mailing address

2131 S CHAMBERS RD
AURORA CO
80014-4503
US

V. Phone/Fax

Practice location:
  • Phone: 303-690-5037
  • Fax:
Mailing address:
  • Phone: 303-690-5037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number27902
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9192
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8888
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: