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NPI Code Detail

MEDICARE: OPEN AND AFFORDABLE DENTAL COMMERCE CITY PLLC

MEDICARE: OPEN AND AFFORDABLE DENTAL COMMERCE CITY PLLC
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
11223D0001XPublic Health Dentistry

Other Identifiers

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

General Provider Information

NPI Number : 1376295691
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPEN AND AFFORDABLE DENTAL COMMERCE CITY PLLC
Provider Business Mailing Address
First Line : 4972 E 62ND AVE UNIT B1
Second Line :
City : COMMERCE CITY
State : CO
Zip : 80022-3253
Country : US
Telephone Number : 303-288-4969
Fax Number : 303-288-4969
Provider Business Practice Location Address
First Line : 4972 E 62ND AVE UNIT B1
Second Line :
City : COMMERCE CITY
State : CO
Zip : 80022-3253
Country : US
Telephone Number : 303-288-4969
Fax Number : 303-288-4969
Authorized Official
Title or Position : OWNER
Name : IGOR TRAKTINSKIY
Credential : DDS
Telephone Number : 303-260-9582
Provider Enumeration Date : 01/19/2022
Last Update Date : 01/19/2022

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Directions to “OPEN AND AFFORDABLE DENTAL COMMERCE CITY PLLC ” Practice Location

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