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General NPI Number Information
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NPI Number | 1164824769
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Entity Type | Organization
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Legal Business Name | COLORADO ORTHODONTICS PROFESSIONAL, LLC
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 9227 E LINCOLN AVE STE #800
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City | LONE TREE
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State | CO
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Zip | 80124-5506
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Country | US
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Telephone | 720-943-2152
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Fax |
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Provider Business Mailing Address
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Address Line | 9227 E LINCOLN AVE STE #800
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City | LONE TREE
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State | CO
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Zip | 80124-5506
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Country | US
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Telephone | 720-943-2152
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | PAUL HAMERSKY
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Credential |
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Telephone | 720-943-2152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4397
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License Number State | CO
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