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NPI Code Detail

MEDICARE: 4TH AVENUE FAMILY DENTISTRY, LLC

MEDICARE: 4TH AVENUE FAMILY DENTISTRY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1013100387
Entity Type Code : Organization
Provider Name (Legal Business Name) : 4TH AVENUE FAMILY DENTISTRY, LLC
Provider Business Mailing Address
First Line : 390 UNIVERSITY BLVD
Second Line :
City : DENVER
State : CO
Zip : 80206-4125
Country : US
Telephone Number : 303-333-0771
Fax Number : 303-333-0779
Provider Business Practice Location Address
First Line : 390 UNIVERSITY BLVD
Second Line :
City : DENVER
State : CO
Zip : 80206-4125
Country : US
Telephone Number : 303-333-0771
Fax Number : 303-333-0779
Authorized Official
Title or Position : DENTIST
Name : DR. THOMAS SWAIN
Credential : DDS
Telephone Number : 303-333-0771
Provider Enumeration Date : 08/21/2007
Last Update Date : 08/21/2007

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Directions to “4TH AVENUE FAMILY DENTISTRY, LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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