MEDICARE: HAMPDEN DENTAL LOFT

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

General Provider Information

NPI Number	:	1740844588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMPDEN DENTAL LOFT

Provider Business Mailing Address
First Line	:	9250 E HAMPDEN AVE STE 100
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-5413
Country	:	US
Telephone Number	:	303-930-8828
Fax Number	:

Provider Business Practice Location Address
First Line	:	9250 E HAMPDEN AVE STE 100
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-5413
Country	:	US
Telephone Number	:	303-930-8828
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. WYNETTE CHAVEZ
Credential	:
Telephone Number	:	303-930-8828

Provider Enumeration Date	:	04/26/2019
Last Update Date	:	04/26/2019

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Directions to “HAMPDEN DENTAL LOFT ” Practice Location

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