Healthcare Provider Details

I. General information

NPI: 1841876653
Provider Name (Legal Business Name): AAA HEALTH CENTERED DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 17TH AVE
LONGMONT CO
80501-9760
US

IV. Provider business mailing address

2120 17TH AVE
LONGMONT CO
80501-9760
US

V. Phone/Fax

Practice location:
  • Phone: 303-776-6021
  • Fax:
Mailing address:
  • Phone: 303-776-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: FRANK G BECVAR
Title or Position: DENTIST
Credential:
Phone: 303-776-6021