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General NPI Number Information
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NPI Number | 1902024425
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Entity Type | Organization
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Legal Business Name | MILE HIGH DENTAL CENTERS
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1727 GILPIN ST
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City | DENVER
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State | CO
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Zip | 80218-1205
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Country | US
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Telephone | 303-388-1661
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Fax |
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Provider Business Mailing Address
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Address Line | 8456 N HEATHER DR
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City | CASTLE ROCK
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State | CO
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Zip | 80108-9119
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Country | US
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Telephone | 303-799-1715
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Fax | 303-799-1717
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Authorized Official
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Title or Position | PRESIDENT
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Name | MALCOLM EDWARD BOONE II
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Credential | D.D.S.
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Telephone | 303-799-1715
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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 | 104302
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License Number State | CO
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