1366085292 NPI number — ESPIRE DENTAL PRACTICE, LLC

Table of content: (NPI 1366085292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366085292 NPI number — ESPIRE DENTAL PRACTICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESPIRE DENTAL PRACTICE, LLC
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:
6
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:
1366085292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7995 E. PRENTICE AVENUE
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
GREENWOOD VILLAGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80111-2713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-699-8206
Provider Business Mailing Address Fax Number:
720-724-9000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8080 E UNION AVENUE
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80237-3614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-745-3182
Provider Business Practice Location Address Fax Number:
720-724-9000
Provider Enumeration Date:
10/23/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
BROOKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
720-810-6443

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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