MEDICARE: ARVADA IMPLANTS AND COSMETIC DENTISTRY P.C.

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
1	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124734132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARVADA IMPLANTS AND COSMETIC DENTISTRY P.C.

Provider Business Mailing Address
First Line	:	15111 PRAIRIE PL
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80023-8789
Country	:	US
Telephone Number	:	720-347-1162
Fax Number	:

Provider Business Practice Location Address
First Line	:	5169 W 64TH AVE
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80003-6531
Country	:	US
Telephone Number	:	720-784-7773
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	TARIQ SAWAQED
Credential	:	DDS
Telephone Number	:	720-347-1162

Provider Enumeration Date	:	01/24/2023
Last Update Date	:	01/24/2023

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