Healthcare Provider Details

I. General information

NPI: 1295198026
Provider Name (Legal Business Name): ALLEGRO ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 E COLFAX AVE
DENVER CO
80218-2404
US

IV. Provider business mailing address

390 S DAYTON ST
DENVER CO
80247-1325
US

V. Phone/Fax

Practice location:
  • Phone: 720-842-4544
  • Fax: 720-842-5343
Mailing address:
  • Phone: 720-842-4544
  • Fax: 720-842-5343

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: DR. ANDREY D NAZAROV
Title or Position: DOCTOR
Credential: DMD, MS
Phone: 720-842-4544