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General NPI Number Information
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NPI Number | 1952847485
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Entity Type | Organization
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Legal Business Name | AURARIA DENTAL OASIS
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Dates
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Enumeration Date | 01/08/2017
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Last Update Date | 01/08/2017
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Provider Practice Location Address
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Address Line | 1050 W COLFAX AVE SUITE G
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City | DENVER
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State | CO
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Zip | 80204-2072
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Country | US
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Telephone | 303-573-5533
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Fax | 303-573-5539
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Provider Business Mailing Address
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Address Line | 1050 W COLFAX AVE SUITE G
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City | DENVER
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State | CO
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Zip | 80204-2072
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Country | US
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Telephone | 303-573-5533
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Fax | 303-573-5539
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Authorized Official
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Title or Position | OWNER
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Name | DR. KELLY KENDALL WHITE
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Credential | DDS
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Telephone | 303-573-5533
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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 | DEN.00104752
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License Number State | CO
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