Healthcare Provider Details

I. General information

NPI: 1104914365
Provider Name (Legal Business Name): DEMETRIOS SYRPES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6855 S HAVANA ST SUITE 540
CENTENNIAL CO
80112-3837
US

IV. Provider business mailing address

6855 S HAVANA ST SUITE 540
CENTENNIAL CO
80112-3837
US

V. Phone/Fax

Practice location:
  • Phone: 303-893-3636
  • Fax: 303-893-3637
Mailing address:
  • Phone: 303-893-3636
  • Fax: 303-893-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8646
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: