Provider Demographics
NPI:1043325756
Name:ASTROTH, JEFFREY DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DALE
Last Name:ASTROTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 N URSULA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:770-848-0687
Mailing Address - Fax:
Practice Address - Street 1:1635 N URSULA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:770-848-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2008-07-29
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-07-29
Provider Licenses
StateLicense IDTaxonomies
CO70921223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice