Healthcare Provider Details

I. General information

NPI: 1093757627
Provider Name (Legal Business Name): DYR SURGASSIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 W 95TH PL
WESTMINSTER CO
80031-2603
US

IV. Provider business mailing address

3464 S WILLOW ST SUITE 154
DENVER CO
80231-4531
US

V. Phone/Fax

Practice location:
  • Phone: 720-540-7155
  • Fax:
Mailing address:
  • Phone: 303-755-2900
  • Fax: 303-755-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBEN Y DATKHAEV
Title or Position: PRESIDENT
Credential: SA
Phone: 720-540-7155