Healthcare Provider Details

I. General information

NPI: 1073042370
Provider Name (Legal Business Name): THERESA SHAVER ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 S PARKER RD STE 201
AURORA CO
80015-1183
US

IV. Provider business mailing address

5001 S PARKER RD STE 201
AURORA CO
80015-1183
US

V. Phone/Fax

Practice location:
  • Phone: 303-751-1313
  • Fax: 303-750-3070
Mailing address:
  • Phone: 303-751-1313
  • Fax: 303-750-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7280
License Number StateCO

VIII. Authorized Official

Name: DR. THERESA LYNN SHAVER
Title or Position: OWNER/ORTHDONTIST
Credential: DDS
Phone: 303-751-1313