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General NPI Number Information
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NPI Number | 1124493291
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Entity Type | Organization
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Legal Business Name | HERO DENTAL OF NE DENVER PC
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 9333 E COLFAX AVE
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City | AURORA
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State | CO
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Zip | 80010-1919
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Country | US
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Telephone | 720-697-5332
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Fax | 720-257-5337
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Provider Business Mailing Address
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Address Line | 2221 E BIJOU ST STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-8009
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Country | US
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Telephone | 719-955-8896
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Fax | 719-955-3470
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | SHAUN URBANOZO
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Credential |
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Telephone | 719-323-2362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN00007992
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License Number State | CO
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