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General NPI Number Information
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NPI Number | 1962884841
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Entity Type | Organization
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Legal Business Name | MAIN STREET DENTAL, PC
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 6240 S MAIN ST STE 295
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City | AURORA
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State | CO
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Zip | 80016-5100
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Country | US
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Telephone | 303-627-5460
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Fax |
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Provider Business Mailing Address
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Address Line | 6240 S MAIN ST STE 295
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City | AURORA
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State | CO
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Zip | 80016-5100
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Country | US
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Telephone | 303-627-5460
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BRIAN LANGENFELD
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Credential | DDS
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Telephone | 303-627-5460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 104888
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License Number State | CO
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