Healthcare Provider Details

I. General information

NPI: 1992195267
Provider Name (Legal Business Name): ALPHA DENTAL CARE V PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 STATION ST STE 175
LONE TREE CO
80124-6808
US

IV. Provider business mailing address

9400 STATION ST SUITE 175
LONE TREE CO
80124-6808
US

V. Phone/Fax

Practice location:
  • Phone: 303-779-2797
  • Fax: 303-779-2687
Mailing address:
  • Phone: 303-779-2797
  • Fax: 303-779-2687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateCO

VIII. Authorized Official

Name: DR. MARY BLAKELEY
Title or Position: PRESIDENT
Credential: DDS
Phone: 303-779-2797