Healthcare Provider Details

I. General information

NPI: 1972747921
Provider Name (Legal Business Name): ERICSON B TENTORI DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 S COLUMBINE ST
DENVER CO
80210-6442
US

IV. Provider business mailing address

2650 S COLUMBINE ST
DENVER CO
80210-6442
US

V. Phone/Fax

Practice location:
  • Phone: 970-433-6837
  • Fax:
Mailing address:
  • Phone: 970-433-6837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33875
License Number StateCO

VIII. Authorized Official

Name: DR. ERICSON B TENTORI
Title or Position: PRESIDENT
Credential: DO
Phone: 970-399-3241