1508197732 NPI number — CHERRY CREEK MODERN DENTISTRY, LLP

Table of content: (NPI 1508197732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508197732 NPI number — CHERRY CREEK MODERN DENTISTRY, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHERRY CREEK MODERN DENTISTRY, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHERRY CREEK MODERN DENTISTRY, LLP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508197732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 920050
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75392-0050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-368-2077
Provider Business Mailing Address Fax Number:
714-368-2092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 S COLORADO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80246-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-758-0575
Provider Business Practice Location Address Fax Number:
303-648-5610
Provider Enumeration Date:
01/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
B. H.
Authorized Official Title or Position:
OWNER DOCTOR
Authorized Official Telephone Number:
303-758-0575

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com