Healthcare Provider Details

I. General information

NPI: 1194883744
Provider Name (Legal Business Name): AARON DEGARMO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 COLFAX AVE., UNIT 1
BENNETT CO
80102
US

IV. Provider business mailing address

200 KENDALL DR
LAMAR CO
81052-3940
US

V. Phone/Fax

Practice location:
  • Phone: 303-644-5058
  • Fax: 303-644-5270
Mailing address:
  • Phone: 719-336-8445
  • Fax: 719-336-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9784
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: