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4101 E Wesley Ave Suite 4 Denver CO 80222-6050 | |
| (303) 758-3230 | |
| (303) 758-3552 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4101 E Wesley Ave, Denver, Colorado |
| Authorized Official Name and Position | Aleksandr Lutskiy (OWNER) |
| Authorized Official Contact | 3037583230 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4101 E Wesley Ave Suite 4 Denver CO 80222-6050 Ph: (303) 758-3230 | 4101 E Wesley Ave Suite 4 Denver CO 80222-6050 Ph: (303) 758-3230 |
| NPI Number | 1710310271 |
|---|---|
| Provider Enumeration Date | 08/19/2013 |
| Last Update Date | 08/19/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710310271 | NPI | - | NPPES |
| 06675883 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 9755 (Colorado) | Primary |
4th Avenue Family Dentistry, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 390 University Blvd, Denver, CO 80206 Phone: 303-333-0771 Fax: 303-333-0779 | |
Jan B Buckstein Dds Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1660 S Albion St, Suite #718, Denver, CO 80222 Phone: 303-757-7759 Fax: 303-757-1501 | |