Healthcare Provider Details

I. General information

NPI: 1649437500
Provider Name (Legal Business Name): AFFORDABLE DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 S FEDERAL BLVD
DENVER CO
80219-2938
US

IV. Provider business mailing address

677 S FEDERAL BLVD
DENVER CO
80219-2938
US

V. Phone/Fax

Practice location:
  • Phone: 303-936-6188
  • Fax:
Mailing address:
  • Phone: 303-936-6188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number105385
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number105385
License Number StateCO

VIII. Authorized Official

Name: PAUL J SMITH
Title or Position: PRINCIPAL/COO
Credential:
Phone: 303-888-7005