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General NPI Number Information
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NPI Number | 1134557259
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Entity Type | Organization
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Legal Business Name | ABC NEIGHBORHOOD DENTAL & ORTHODONTIC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 1250 S BUCKLEY RD UNIT M
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City | AURORA
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State | CO
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Zip | 80017-4180
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Country | US
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Telephone | 303-337-3300
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Fax | 303-337-3301
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Provider Business Mailing Address
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Address Line | 1250 S BUCKLEY RD UNIT M
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City | AURORA
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State | CO
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Zip | 80017-4180
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Country | US
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Telephone | 303-337-3300
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Fax | 303-337-3301
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL SHIFMAN
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Credential | DDS
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Telephone | 303-337-3300
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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 | 10381
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License Number State | CO
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