1568950673 NPI number — AURORA VILLAGE MODERN DENTISTRY, LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568950673 NPI number — AURORA VILLAGE MODERN DENTISTRY, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA VILLAGE 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:
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:
1568950673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2022
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:
714-845-8890
Provider Business Mailing Address Fax Number:
303-952-0892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 S PARKER RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-595-5454
Provider Business Practice Location Address Fax Number:
303-595-5454
Provider Enumeration Date:
04/24/2018

Additional Information

Authorized Official

Authorized Official Last Name:
VILAR
Authorized Official First Name:
DANA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-595-5454

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)





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