Healthcare Provider Details

I. General information

NPI: 1972647303
Provider Name (Legal Business Name): CODY DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 E AMHERST AVE
DENVER CO
80222-6790
US

IV. Provider business mailing address

4301 E AMHERST AVE
DENVER CO
80222-6790
US

V. Phone/Fax

Practice location:
  • Phone: 303-758-5858
  • Fax: 303-758-6753
Mailing address:
  • Phone: 303-758-5858
  • Fax: 303-758-6753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3514
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3767
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number486
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number546
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7996
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8359
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number487
License Number StateCO
# 8
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6773
License Number StateCO
# 9
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7077
License Number StateCO
# 10
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. WESSELY K CHAMBERS
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 303-758-5858