| Family Dentistry | |
|
1756 Vine St Denver CO 80206-1120 | |
| (303) 322-1177 | |
| (303) 322-1199 |
| Full Name | Family Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1756 Vine St, 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 |
|---|---|
| Family Dentistry 1756 Vine Street Denver CO 80206 Ph: (303) 322-1177 | Family Dentistry 1756 Vine St Denver CO 80206-1120 Ph: (303) 322-1177 |
| NPI Number | 1316292097 |
|---|---|
| Provider Enumeration Date | 07/18/2012 |
| Last Update Date | 07/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316292097 | NPI | - | NPPES |
| 17178061 | Medicaid | CO | |
| 02014769 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 104176 (Colorado) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 105493 (Colorado) | Secondary |
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 | |