Healthcare Provider Details

I. General information

NPI: 1912022393
Provider Name (Legal Business Name): ERICSON B TENTORI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ERIC B TENTORI D.O.

II. Dates (important events)

Enumeration Date: 03/21/2007
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 Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number33875
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: