=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831010495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORMOSA DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2026
-----------------------------------------------------
Last Update Date | 07/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15389 W 91ST DR STE 201
-----------------------------------------------------
City | ARVADA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80007-1405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-608-3988
-----------------------------------------------------
Fax | 720-608-8078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5850 CENTRAL AVE UNIT 523
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80031-2984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-608-3988
-----------------------------------------------------
Fax | 720-608-8078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | JEREMY CHEN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 408-888-8645
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------