Healthcare Provider Details

I. General information

NPI: 1710450192
Provider Name (Legal Business Name): ABS DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 S CLERMONT ST
DENVER CO
80222-5006
US

IV. Provider business mailing address

2101 S CLERMONT ST
DENVER CO
80222-5006
US

V. Phone/Fax

Practice location:
  • Phone: 303-691-3333
  • Fax: 720-666-6036
Mailing address:
  • Phone: 303-691-3333
  • Fax: 720-666-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ATOUSA B SAFAVI
Title or Position: DENTIST/OWNER
Credential: MS, DDS
Phone: 919-428-4525