=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689797086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONALD A DECINO, D.D.S., P,C,
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3405 S YARROW ST SUITE A
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80227-4965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-996-8500
-----------------------------------------------------
Fax | 303-996-8501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3405 S YARROW ST SUITE A
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80227-4965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-996-8500
-----------------------------------------------------
Fax | 303-996-8501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DONALD ALFRED DECINO
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 303-996-8500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 5926
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------