Healthcare Provider Details

I. General information

NPI: 1114307899
Provider Name (Legal Business Name): DENVER ANESTHESIA DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 LAKESHORE DR
LITTLETON CO
80123
US

IV. Provider business mailing address

5420 LAKESHORE DR
LITTLETON CO
80123
US

V. Phone/Fax

Practice location:
  • Phone: 917-340-0642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number00202170
License Number StateCO

VIII. Authorized Official

Name: MICHAEL RIGGS
Title or Position: OWNER
Credential:
Phone: 917-340-0642