| |
3300 E 1st Ave Ste 690 Denver CO 80206-5809 | |
(720) 356-4010 | |
(303) 736-7253 |
Full Name | |
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Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
Location | 3300 E 1st Ave Ste 690, Denver, Colorado |
Authorized Official Name and Position | Michael Driessen (REGISTERED AGENT AND OFFICER) |
Authorized Official Contact | 8183063215 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1942 Caminito De La Estrella Glendale CA 91208-3000 Ph: (818) 306-3215 | 3300 E 1st Ave Ste 690 Denver CO 80206-5809 Ph: (720) 356-4010 |
NPI Number | 1528544582 |
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Provider Enumeration Date | 07/12/2018 |
Last Update Date | 11/07/2018 |
Identifier | Type | State | Issuer |
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1528544582 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (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 | |