Healthcare Provider Details

I. General information

NPI: 1225156201
Provider Name (Legal Business Name): ANDREY D NAZAROV DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S. DAYTON ST.
DENVER CO
80247
US

IV. Provider business mailing address

390 S. DAYTON ST.
DENVER CO
80247
US

V. Phone/Fax

Practice location:
  • Phone: 720-842-4544
  • Fax: 303-755-1979
Mailing address:
  • Phone: 720-842-4544
  • Fax: 303-755-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8530
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: