MEDICARE: DENVER GRIN ORTHO, 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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1477384014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENVER GRIN ORTHO, PLLC

Provider Business Mailing Address
First Line	:	7999 S COUNTRY CLUB PKWY
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-1195
Country	:	US
Telephone Number	:	720-285-7972
Fax Number	:	877-444-4055

Provider Business Practice Location Address
First Line	:	2910 E COLFAX AVE STE 110
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1605
Country	:	US
Telephone Number	:	720-285-7972
Fax Number	:	303-330-0714

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	COLTON FLAKE
Credential	:	DDS
Telephone Number	:	720-285-7972

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	08/13/2024

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