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General NPI Number Information
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NPI Number | 1104127695
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF COLORADO SCHOOL OF DENTAL MEDICINE
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 13065 E 17TH AVE
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City | AURORA
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State | CO
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Zip | 80045-2532
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Country | US
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Telephone | 303-724-7044
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Fax | 303-724-6999
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Provider Business Mailing Address
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Address Line | 13065 E 17TH AVE
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City | AURORA
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State | CO
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Zip | 80045-2532
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Country | US
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Telephone | 303-724-7044
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Fax | 303-724-6999
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Authorized Official
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Title or Position | ASSOCIATE DEAN OF ACADEMIC AFFAIRS
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Name | DR. RANDY KLUENDER
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Credential | DDS
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Telephone | 303-724-7124
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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 | 200936
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License Number State | CO
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