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General NPI Number Information
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NPI Number | 1740552371
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Entity Type | Organization
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Legal Business Name | MILE HIGH DENTISTRY
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 11275 E MISSISSIPPI AVE #2W1
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City | AURORA
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State | CO
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Zip | 80012-3263
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Country | US
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Telephone | 303-364-7631
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Fax |
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Provider Business Mailing Address
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Address Line | 11275 E MISSISSIPPI AVE #2W1
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City | AURORA
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State | CO
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Zip | 80012-3263
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Country | US
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Telephone | 303-364-7631
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN LEY
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Credential |
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Telephone | 303-364-7631
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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 | 7976
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License Number State | CO
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