1023119203 NPI number — PAUL ANDREATTA D.D.S.P.C.

Table of content: (NPI 1023119203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023119203 NPI number — PAUL ANDREATTA D.D.S.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL ANDREATTA D.D.S.P.C.
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:
Provider Other Organization Name Type Code:
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:
1023119203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1723 E. MAIN ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRINIDAD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-846-4028
Provider Business Mailing Address Fax Number:
719-845-0097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1723 E. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRINIDAD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-846-4028
Provider Business Practice Location Address Fax Number:
719-845-0097
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREATTA
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
719-846-4028

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)

  • Identifier: BLUE CROSS BLUE SHIE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: DELTA DENTAL . This is a "DELTA DENTAL" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: AETNA HEALTH PLAN UP . This is a "AETNA HEALTH UPS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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