Healthcare Provider Details

I. General information

NPI: 1598859662
Provider Name (Legal Business Name): M.S.D. ENDODONTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12297 PENNSYLVANIA ST SUITE 2
THORNTON CO
80241-3165
US

IV. Provider business mailing address

12297 PENNSYLVANIA ST SUITE 2
THORNTON CO
80241-3165
US

V. Phone/Fax

Practice location:
  • Phone: 303-920-4196
  • Fax: 303-920-4198
Mailing address:
  • Phone: 303-920-4196
  • Fax: 303-920-4198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6963
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MATTHEW S DAVIS
Title or Position: PRESIDENT/OWNER
Credential: D.D.S.
Phone: 303-920-4196