Provider Demographics
NPI:1033655493
Name:DANDELION MEDICAL AESTHETICS, LLC
Entity Type:Organization
Organization Name:DANDELION MEDICAL AESTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:720-471-7017
Mailing Address - Street 1:8174 S. KIPLING PKWY #190
Mailing Address - Street 2:SUITE 119
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6320
Mailing Address - Country:US
Mailing Address - Phone:720-471-7017
Mailing Address - Fax:
Practice Address - Street 1:8174 S. KIPLING PKWY #190
Practice Address - Street 2:SUITE 119
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-6320
Practice Address - Country:US
Practice Address - Phone:720-471-7017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991292-NP261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58482539Medicaid
CO400939YUXKMedicare UPIN