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Provider Information for 1144428962

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1144428962

Calendar   Last Updated:  2007-07-08
  Certification Date: 


Name Value
NPI 1144428962
Enumeration Date 2007-07-03
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 16443 E JACKALOPE DR
PARKER, CO 80134-3174
United States

Phone: 303-548-9523 | Fax: 303-841-3447
View Map External Link
Primary Practice Address 11280 S TWENTY MILE RD SUITE 115
PARKER, CO 80134-4914
United States

Phone: 303-841-7177 | Fax: 303-841-3447
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CO 9414