Healthcare Provider Details

I. General information

NPI: 1861900029
Provider Name (Legal Business Name): 35TH AVENUE ENETERPRISES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3195 W 35TH AVE
DENVER CO
80211-2703
US

IV. Provider business mailing address

3195 W 35TH AVE
DENVER CO
80211-2703
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-4350
  • Fax:
Mailing address:
  • Phone: 303-399-4350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateCO

VIII. Authorized Official

Name: TODD RINALDI
Title or Position: PRESIDENT
Credential:
Phone: 303-399-4350