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General NPI Number Information
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NPI Number | 1144767336
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Entity Type | Organization
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Legal Business Name | EMPIRE DENTAL LLC
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 1076 S SABLE BLVD
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City | AURORA
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State | CO
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Zip | 80012-3796
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Country | US
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Telephone | 303-369-5517
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Fax |
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Provider Business Mailing Address
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Address Line | 5365 SPINE RD STE D
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City | BOULDER
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State | CO
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Zip | 80301-3324
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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 | MBR
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Name | DR. NICHOLAS SIGMAN
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Credential | DDS
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Telephone | 816-547-0941
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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 | 10770
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License Number State | CO
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