Healthcare Provider Details

I. General information

NPI: 1538765680
Provider Name (Legal Business Name): OPEN AND AFFORDABLE DENTAL ARVADA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 WARD RD STE 100
WHEAT RIDGE CO
80033-1952
US

IV. Provider business mailing address

7207 GRANDVIEW AVE
ARVADA CO
80002-2501
US

V. Phone/Fax

Practice location:
  • Phone: 303-351-1022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GAVIN WHITMAN
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 509-554-8244