Healthcare Provider Details

I. General information

NPI: 1780065797
Provider Name (Legal Business Name): BEAR DENTAL GROUP PROF. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10815 W JEWELL AVE SUITE L
LAKEWOOD CO
80232-4851
US

IV. Provider business mailing address

10815 W JEWELL AVE SUITE L
LAKEWOOD CO
80232-4851
US

V. Phone/Fax

Practice location:
  • Phone: 303-988-6860
  • Fax: 303-989-2058
Mailing address:
  • Phone: 303-988-6860
  • Fax: 303-989-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number9539
License Number StateCO

VIII. Authorized Official

Name: DR. JENNIFER LEE
Title or Position: OWNER
Credential: DDS
Phone: 720-240-1028