Healthcare Provider Details

I. General information

NPI: 1184848194
Provider Name (Legal Business Name): JLS MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2789 W ALAMEDA AVE
DENVER CO
80219-3042
US

IV. Provider business mailing address

2789 W ALAMEDA AVE
DENVER CO
80219-3042
US

V. Phone/Fax

Practice location:
  • Phone: 303-935-1705
  • Fax:
Mailing address:
  • Phone: 303-935-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0651
License Number StateCO

VIII. Authorized Official

Name: MR. JONATHAN STRANGE
Title or Position: PRESIDENT
Credential:
Phone: 303-935-1705