Provider Demographics
NPI:1144230103
Name:DENVER WEST DENTAL GROUP
Entity Type:Organization
Organization Name:DENVER WEST DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:SABURO
Authorized Official - Last Name:KAWAKAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-279-5050
Mailing Address - Street 1:14062 DENVER WEST PARKWAY
Mailing Address - Street 2:#52-120
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401
Mailing Address - Country:US
Mailing Address - Phone:303-279-5050
Mailing Address - Fax:303-279-1645
Practice Address - Street 1:14062 DENVER WEST PARKWAY
Practice Address - Street 2:#52-120
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401
Practice Address - Country:US
Practice Address - Phone:303-279-5050
Practice Address - Fax:303-279-1645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4971122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty