Healthcare Provider Details

I. General information

NPI: 1710360359
Provider Name (Legal Business Name): DENVER RESTORATIVE DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8181 ARISTA PL UNIT 140
BROOMFIELD CO
80021-7918
US

IV. Provider business mailing address

8181 ARISTA PL UNIT 140
BROOMFIELD CO
80021-7918
US

V. Phone/Fax

Practice location:
  • Phone: 303-427-4120
  • Fax: 303-427-4009
Mailing address:
  • Phone: 303-427-4120
  • Fax: 303-427-4009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number202267
License Number StateCO

VIII. Authorized Official

Name: FELICIA LYNN LOSLI
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-427-4120