Provider Demographics
NPI:1003170101
Name:DENTAL MANAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:DENTAL MANAGEMENT GROUP LLC
Other - Org Name:AFFORDABLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDHOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-394-0231
Mailing Address - Street 1:11246 E MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3202
Mailing Address - Country:US
Mailing Address - Phone:303-394-0231
Mailing Address - Fax:303-329-4622
Practice Address - Street 1:3216 HIGH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4062
Practice Address - Country:US
Practice Address - Phone:303-394-0231
Practice Address - Fax:303-329-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO66161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty