Healthcare Provider Details

I. General information

NPI: 1790292431
Provider Name (Legal Business Name): ALIX GREENMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6179 S BALSAM WAY STE 100
LITTLETON CO
80123-3092
US

IV. Provider business mailing address

398 CRESCENT LAKE RD
GOLDEN CO
80403-9401
US

V. Phone/Fax

Practice location:
  • Phone: 303-933-8282
  • Fax: 303-948-5610
Mailing address:
  • Phone: 303-917-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN.00008258
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: