Healthcare Provider Details

I. General information

NPI: 1679337588
Provider Name (Legal Business Name): DAVE LEE-ROY ANCION DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15151 E 104TH AVE STE 103
COMMERCE CITY CO
80022-8948
US

IV. Provider business mailing address

9345 E 56TH AVE APT 378
DENVER CO
80238-4447
US

V. Phone/Fax

Practice location:
  • Phone: 303-287-7000
  • Fax:
Mailing address:
  • Phone: 786-752-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00206135
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: