Provider Demographics
NPI:1013368760
Name:OPEN AND AFFORDABLE DENTAL AT HUDSON PLLC
Entity Type:Organization
Organization Name:OPEN AND AFFORDABLE DENTAL AT HUDSON PLLC
Other - Org Name:OPEN AND AFFORDABLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:STOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-580-1117
Mailing Address - Street 1:101 E. BISON HWY, UNIT A
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:CO
Mailing Address - Zip Code:80642
Mailing Address - Country:US
Mailing Address - Phone:720-580-1117
Mailing Address - Fax:
Practice Address - Street 1:101 E. BISON HWY, UNIT A
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:CO
Practice Address - Zip Code:80642
Practice Address - Country:US
Practice Address - Phone:720-580-1117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002020241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96407069Medicaid