=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518053404
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MESSINGHAM ORTHODONTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7523 W 80TH AVE
-----------------------------------------------------
City | ARVADA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80003-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-456-5339
-----------------------------------------------------
Fax | 303-456-5843
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7523 W 80TH AVE
-----------------------------------------------------
City | ARVADA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80003-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-456-5339
-----------------------------------------------------
Fax | 303-456-5843
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JASON ANDREW MESSINGHAM
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 303-456-5339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 8555
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------