Healthcare Provider Details

I. General information

NPI: 1649785197
Provider Name (Legal Business Name): 5280 DENTISTRY AND ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 GLENARM PL
DENVER CO
80205-3129
US

IV. Provider business mailing address

2422 GLENARM PL
DENVER CO
80205-3129
US

V. Phone/Fax

Practice location:
  • Phone: 602-391-8331
  • Fax:
Mailing address:
  • Phone: 602-391-8331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberDEN.202500
License Number StateCO

VIII. Authorized Official

Name: DR. ZACHARY XAVIER VAN HILSEN
Title or Position: OWNER
Credential: DDS, MS
Phone: 602-391-8331