Full Name | |
---|---|
Speciality | Dentist - General Practice |
Location | 1756 Vine Street, Denver, Colorado |
Authorized Official Name and Position | Collis Johnson (DENTIST/OWNER) |
Authorized Official Contact | 3033221177 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1756 Vine Street Denver CO 80206 Ph: (303) 322-1177 | 1756 Vine Street Denver CO 80206 Ph: (303) 322-1177 |
NPI Number | 1558607242 |
---|---|
Provider Enumeration Date | 12/27/2012 |
Last Update Date | 12/27/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558607242 | NPI | - | NPPES |
02014769 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 104176 (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 | |