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General NPI Number Information
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NPI Number | 1003173576
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Entity Type | Individual
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Provider Name | JOSHUA JACKSTIEN DMD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8301 E PRENTICE AVE STE 215
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2990
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Country | US
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Telephone | 720-606-4220
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Fax | 720-606-4221
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Provider Business Mailing Address
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Address Line | 8301 E PRENTICE AVE STE 215
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2990
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Country | US
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Telephone | 720-606-4220
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Fax | 720-606-4221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 8590166-9924
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 00201856
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License Number State | CO
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