Healthcare Provider Details

I. General information

NPI: 1609314368
Provider Name (Legal Business Name): IVAN QUINTANA HIJANO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11246 E MISSISSIPPI AVE
AURORA CO
80012-3202
US

IV. Provider business mailing address

11246 E MISSISSIPPI AVE
AURORA CO
80012-3202
US

V. Phone/Fax

Practice location:
  • Phone: 303-344-0810
  • Fax:
Mailing address:
  • Phone: 303-344-0810
  • Fax: 303-344-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2017002288
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN.00204448
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: