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General NPI Number Information
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NPI Number | 1104283902
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Entity Type | Organization
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Legal Business Name | BREEZE DENTAL, P.C.
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 2226 S FRASER ST UNIT #1
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City | AURORA
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State | CO
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Zip | 80014-4533
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Country | US
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Telephone | 303-752-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 2226 S FRASER ST UNIT #1
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City | AURORA
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State | CO
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Zip | 80014-4533
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | MELISSA FARBOD
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Credential |
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Telephone | 303-752-2226
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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 | 10529
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License Number State | CO
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