Healthcare Provider Details

I. General information

NPI: 1932589132
Provider Name (Legal Business Name): DENVER RESTORATIVE DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8774 YATES DR STE 340
WESTMINSTER CO
80031-6906
US

IV. Provider business mailing address

8774 YATES DR STE 340
WESTMINSTER CO
80031-6906
US

V. Phone/Fax

Practice location:
  • Phone: 303-427-4120
  • Fax:
Mailing address:
  • Phone: 303-427-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number202267
License Number StateCO

VIII. Authorized Official

Name: TAYLOR GOGGINS
Title or Position: OWNER/DOCTOR
Credential: DDS
Phone: 303-427-4120