Provider Demographics
NPI:1104202126
Name:GREGORY R BEVANS DDS
Entity Type:Organization
Organization Name:GREGORY R BEVANS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-758-5747
Mailing Address - Street 1:6740 E HAMPDEN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3019
Mailing Address - Country:US
Mailing Address - Phone:303-758-5747
Mailing Address - Fax:303-758-8650
Practice Address - Street 1:6740 E HAMPDEN AVE STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3019
Practice Address - Country:US
Practice Address - Phone:303-758-5747
Practice Address - Fax:303-758-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106316261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental