MEDICARE: MILE HIGH DENTAL CENTERS

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	104302	CO

General Provider Information

NPI Number	:	1902024425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILE HIGH DENTAL CENTERS

Provider Business Mailing Address
First Line	:	8456 N HEATHER DR
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-9119
Country	:	US
Telephone Number	:	303-799-1715
Fax Number	:	303-799-1717

Provider Business Practice Location Address
First Line	:	1727 GILPIN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1205
Country	:	US
Telephone Number	:	303-388-1661
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MALCOLM EDWARD BOONE II
Credential	:	D.D.S.
Telephone Number	:	303-799-1715

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	08/22/2020

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Directions to “MILE HIGH DENTAL CENTERS ” Practice Location

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