Healthcare Provider Details

I. General information

NPI: 1962530758
Provider Name (Legal Business Name): CLIFTON CORY SPEAKS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 IRVING ST SUITE 201
DENVER CO
80211-3636
US

IV. Provider business mailing address

2763 KING ST
DENVER CO
80211-4028
US

V. Phone/Fax

Practice location:
  • Phone: 303-292-1780
  • Fax:
Mailing address:
  • Phone: 720-496-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN9291
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN-9291
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: