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General NPI Number Information
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NPI Number | 1912678608
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Entity Type | Organization
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Legal Business Name | MACK FAMILY DENTAL PC
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 15250 E. ORCHARD RD.
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City | CENTENNIAL
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State | CO
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Zip | 80016
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Country | US
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Telephone | 303-690-5037
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Fax | 720-640-0550
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Provider Business Mailing Address
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Address Line | 15250 E. ORCHARD RD.
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City | CENTENNIAL
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State | CO
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Zip | 80016
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Country | US
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Telephone | 303-690-5037
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Fax | 720-640-0550
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Authorized Official
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Title or Position | OWNER
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Name | ERIC L MACK
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Credential | DDS
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Telephone | 303-690-5037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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