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General NPI Number Information
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NPI Number | 1740649839
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Entity Type | Individual
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Provider Name | JUSTIN FORD BECERRA DDS
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Gender | Male
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 2323 S WADSWORTH BLVD STE 1778
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City | LAKEWOOD
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State | CO
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Zip | 80227-3274
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Country | US
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Telephone | 303-980-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 11332 CENTRAL CT APT 15209
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City | BROOMFIELD
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State | CO
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Zip | 80021-5045
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Country | US
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Telephone | 808-979-4771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 00202851
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN.00202851
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License Number State | CO
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