Healthcare Provider Details

I. General information

NPI: 1336294388
Provider Name (Legal Business Name): ALTURA PERIODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 S YOSEMITE ST
DENVER CO
80237-1827
US

IV. Provider business mailing address

3690 S YOSEMITE ST
DENVER CO
80237-1826
US

V. Phone/Fax

Practice location:
  • Phone: 303-695-0990
  • Fax: 303-695-6915
Mailing address:
  • Phone: 303-695-0990
  • Fax: 303-695-6915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number104955
License Number StateCO

VIII. Authorized Official

Name: DR. ALAN POMERANZ
Title or Position: OWNER
Credential:
Phone: 303-609-0990