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General NPI Number Information
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NPI Number | 1023417250
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Entity Type | Organization
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Legal Business Name | 58 DENTAL
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 7090 E HAMPDEN AVE SUITE C
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City | DENVER
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State | CO
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Zip | 80224-3022
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Country | US
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Telephone | 303-758-5252
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Fax | 303-691-1937
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Provider Business Mailing Address
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Address Line | 7090 E HAMPDEN AVE SUITE C
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City | DENVER
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State | CO
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Zip | 80224-3022
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Country | US
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Telephone | 303-758-5252
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Fax | 303-691-1937
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KYLE RYAN GRIFFITH
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Credential | D.M.D
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Telephone | 617-861-5809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 00201927
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License Number State | CO
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