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General NPI Number Information
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NPI Number | 1356686182
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN DENTAL IMPLANT CENTER
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 1900 16TH ST SUITE 1150
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City | DENVER
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State | CO
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Zip | 80202-5120
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Country | US
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Telephone | 303-515-6700
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Fax | 888-484-0355
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Provider Business Mailing Address
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Address Line | 1900 16TH ST SUITE 1150
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City | DENVER
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State | CO
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Zip | 80202-5120
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Country | US
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Telephone | 303-515-6700
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Fax | 888-484-0355
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Authorized Official
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Title or Position | OWNER/SOLE MBR
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Name | DR. JUSTIN DAVID MOODY
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Credential | DDS
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Telephone | 303-515-6700
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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 | DEN 9555
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License Number State | CO
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