Healthcare Provider Details

I. General information

NPI: 1699036715
Provider Name (Legal Business Name): DENNIS EDMUND PAIGE CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 08/19/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1079 JOLIET ST
AURORA CO
80010-4047
US

IV. Provider business mailing address

1079 JOLIET ST
AURORA CO
80010-4047
US

V. Phone/Fax

Practice location:
  • Phone: 303-815-4708
  • Fax:
Mailing address:
  • Phone: 303-815-4708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: