MEDICARE: HERO DENTAL OF COMMERCE CITY PC

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	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DEN00009208	OTHER	CO	CO LICENSE

General Provider Information

NPI Number	:	1598318123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERO DENTAL OF COMMERCE CITY PC

Provider Business Mailing Address
First Line	:	2221 E BIJOU ST STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-8009
Country	:	US
Telephone Number	:	719-576-1850
Fax Number	:	719-955-3470

Provider Business Practice Location Address
First Line	:	6075 E PARKWAY DR STE 160
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-5413
Country	:	US
Telephone Number	:	720-795-7077
Fax Number	:	719-955-3470

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	SHAUN URBANOZO
Credential	:
Telephone Number	:	719-323-2362

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	11/18/2020

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Directions to “HERO DENTAL OF COMMERCE CITY PC ” Practice Location

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