1407443377 NPI number — FIRST CHOICE DENTAL 2, PROFESSIONAL LLC

Table of content: (NPI 1407443377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407443377 NPI number — FIRST CHOICE DENTAL 2, PROFESSIONAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CHOICE DENTAL 2, PROFESSIONAL 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:
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:
1407443377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10963 E EVANS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80014-4721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-352-2333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2221 S PARKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80231-3482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-320-0734
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ABDULAMEER
Authorized Official First Name:
WAMEEDH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
720-352-2333

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 28821351 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34000259 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: DEN00201910 . This is a "STATE LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: DEN201918 . This is a "STATE LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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