1629282850 NPI number — ADVANCED ORTHODONTICS

Table of content: (NPI 1629282850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629282850 NPI number — ADVANCED ORTHODONTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED ORTHODONTICS
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:
DR. KIRK J. NIELSON D.D.S., M.S.
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:
1629282850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16756 E SMOKY HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80015-2470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-248-7200
Provider Business Mailing Address Fax Number:
303-680-1157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16756 E SMOKY HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80015-2470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-248-7200
Provider Business Practice Location Address Fax Number:
303-680-1157
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NIELSON
Authorized Official First Name:
KIRK
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-690-0400

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  6826 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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