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General NPI Number Information
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NPI Number | 1225485873
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Entity Type | Organization
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Legal Business Name | DENTISTRY 360
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 5140 W DARTMOUTH AVE
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City | DENVER
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State | CO
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Zip | 80236-2007
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Country | US
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Telephone | 720-596-4760
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Fax | 720-596-4943
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Provider Business Mailing Address
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Address Line | 5140 W DARTMOUTH AVE
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City | DENVER
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State | CO
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Zip | 80236-2007
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Country | US
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Telephone | 720-596-4760
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Fax | 720-596-4943
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SEMIRAMIDA CONDOIANIS
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Credential | DDS
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Telephone | 720-596-4760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 00010276
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License Number State | CO
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