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General NPI Number Information
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NPI Number | 1710474374
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Entity Type | Organization
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Legal Business Name | PALOMA DENTAL
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 1225 35TH STREET
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City | DENVER
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State | CO
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Zip | 80205
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Country | US
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Telephone | 720-440-7743
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 35TH STREET
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City | DENVER
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State | CO
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Zip | 80205
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Country | US
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Telephone | 720-440-7743
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Fax |
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Authorized Official
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Title or Position | FRONT OFFICE COORDINATOR
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Name | SARA SMITH
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Credential |
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Telephone | 720-440-7743
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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 | DEN.00202416
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License Number State | CO
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