| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1756 Vine St, Denver, Colorado |
| Authorized Official Name and Position | Collis Johnson (DENTIST OWNER PC) |
| Authorized Official Contact | 3033221177 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1756 Vine St Denver CO 80206 Ph: (303) 322-1177 | 1756 Vine St Denver CO 80206 Ph: (303) 322-1177 |
| NPI Number | 1922212943 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 09/02/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922212943 | NPI | - | NPPES |
| 1831291855 | Other | CO | NATIONAL PROVIDER TYPEI |
| 02014769 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 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 | |