| I D Dental Clinic | |
|
777 Bannock St Mc 1923 Denver CO 80204-4507 | |
| (303) 436-6000 | |
| Not Available |
| Full Name | I D Dental Clinic |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 777 Bannock St, Denver, Colorado |
| Authorized Official Name and Position | Peggy J Burnette (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3036024964 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| I D Dental Clinic 777 Bannock St Mc 1923 Denver CO 80204-4507 Ph: (303) 436-6000 | I D Dental Clinic 777 Bannock St Mc 1923 Denver CO 80204-4507 Ph: (303) 436-6000 |
| NPI Number | 1477746105 |
|---|---|
| Provider Enumeration Date | 08/27/2007 |
| Last Update Date | 12/28/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477746105 | NPI | - | NPPES |
| 04019220 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | 010444 (Colorado) | Primary |
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