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General NPI Number Information
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NPI Number | 1215592993
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Entity Type | Organization
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Legal Business Name | BUCKLEY DENTAL LOFT
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 1710 S BUCKLEY RD UNIT 8A
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City | AURORA
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State | CO
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Zip | 80017-5639
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Country | US
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Telephone | 303-696-6763
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 S BUCKLEY RD UNIT 8A
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City | AURORA
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State | CO
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Zip | 80017-5639
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Country | US
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Telephone | 303-696-6763
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | WYNETTE CHAVEZ
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Credential |
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Telephone | 36-963-6763
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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 |
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