=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033411152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFFORDABLE DENTURES - NORTHGLENN, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2010
-----------------------------------------------------
Last Update Date | 02/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 680 E 120TH AVE SUITE D
-----------------------------------------------------
City | NORTHGLENN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80233-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-252-8820
-----------------------------------------------------
Fax | 303-252-8822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 E 120TH AVE SUITE D
-----------------------------------------------------
City | NORTHGLENN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80233-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-252-8820
-----------------------------------------------------
Fax | 303-252-8822
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WALTER E SCHNEIDER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 303-252-8820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------