Provider Demographics
NPI:1093301046
Name:DALE AUDREY INC.
Entity Type:Organization
Organization Name:DALE AUDREY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:AUDREY
Authorized Official - Last Name:UNGAR
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:303-728-9746
Mailing Address - Street 1:1499 BLAKE ST APT 1H
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1356
Mailing Address - Country:US
Mailing Address - Phone:954-668-7061
Mailing Address - Fax:
Practice Address - Street 1:1499 BLAKE ST APT 1H
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1356
Practice Address - Country:US
Practice Address - Phone:303-728-9746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty