| Full Name | |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 3216 High St, Denver, Colorado |
| Authorized Official Name and Position | Major W. Tappan (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3033940231 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3216 High St Denver CO 80205-4062 Ph: (970) 394-0231 | 3216 High St Denver CO 80205-4062 Ph: (970) 394-0231 |
| NPI Number | 1215113402 |
|---|---|
| Provider Enumeration Date | 01/17/2008 |
| Last Update Date | 01/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215113402 | NPI | - | NPPES |
| 02036424 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | (* (Not Available)) | 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 | |