Healthcare Provider Details

I. General information

NPI: 1376928945
Provider Name (Legal Business Name): DEL MAR KID'S DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 PEORIA ST STE A
AURORA CO
80011-8215
US

IV. Provider business mailing address

797 PEORIA ST STE A
AURORA CO
80011-8215
US

V. Phone/Fax

Practice location:
  • Phone: 303-577-0062
  • Fax:
Mailing address:
  • Phone: 303-577-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberDEN.00202598
License Number StateCO

VIII. Authorized Official

Name: HUONG NGUYEN
Title or Position: DENTIST
Credential:
Phone: 303-523-7808