Healthcare Provider Details

I. General information

NPI: 1205427895
Provider Name (Legal Business Name): SEAN OGRADY DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 UMATILLA ST
DENVER CO
80211-1534
US

IV. Provider business mailing address

4402 UMATILLA ST
DENVER CO
80211-1534
US

V. Phone/Fax

Practice location:
  • Phone: 720-551-6580
  • Fax: 720-551-6581
Mailing address:
  • Phone: 720-551-6580
  • Fax: 720-551-6581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SEAN OGRADY
Title or Position: DENTIST/CEO/OWNER
Credential:
Phone: 720-551-6580